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Full text of "The Canadian Nurse Volume 76"

I ' 

ABBOTT, Susan 
CNF Scholarship, 2S0c 

Hypothermia and the senior citizen, 33Fe 

Seniors: A target for nutrition education 
(Gillis) 28J/A 
Torture and the nurse, 10Ja 

A self-help guide to the aging process 
(Morden) 19J/A 
AARN scholarship winners, ISJa 

AWS: recognition and rehabilitation 
(Kolesar, Shaw) 49N 
A health-oriented approach (Paech) E, 18N 
A learning program in the addictions 
(McGee) 22N 
AWS: recognition and rehabilitation 
(Kolesar, Shaw) 49N 
Breaking the cycle of abuse (Casselman) 
It could happen to you! (Kolesar) 20N 
Understanding the physiology of alcohol 
abuse (Gaerlan) 46N 
ALLEN, Marion 
A practical goal for the 80's (Slater) E, 6S 
ANNABLE, Mary Lou 
CNA Ticket of Nominations (port) 28Ap 


The official journal of the Canadian Nurses 
Association published in French and English 
editions eleven times per year. 



Vol. 76, No.'s 1-11 

January - December 


A - Abstract 
A V-Audiovisual 



Ja - January 
Fe - February 
Mr - March 
Ap - April 
My - May 
Je - June 



Man versus microbe: a case for the 
Infection Control Nurse 
(Ratsoy, Beaufoy) 30D 
Care for the caregiver (Vachon) 280c 

SOJa, S4Ap, 49Je, 48J/A, HOc, 14D 
Alcohol and your patient, 49Je 
A catalogue of audiovisual resources in 
psychiatric mental health nursing, 230c 
A special place, 14D 
Autism, minority of one, SOJa 
Burns, SOJa 
Can I take this if I'm pregnant - brochure, 
Childbirth, a labor of love, SOJa 
Childbirth, pregnancy: two people, SOJa 
Choking: to save a life, SOJ a 
Continuing education, SOJa 
Fit to sing, S4Ap 
General nursing care, 49Je 
Health Computer Applications in Canada, 
Help for special services, 14D 
Lifestyles, SOJa 
Material on breast feeding, 230c 
Maternity Care Checklist, 14D 
Medications, 49Je 
Patient education, SOJa 
Periodic health examination, 14D 
Reports - The Canadian Institute of Child 
Health, 230c 
Resuscitation, SOJa 
Shopping for audiovisuals (Carver) 48J/A 
The fit-kit: The Canadian Home Fitness 
Program, S4Ap 
The ups and downs of blood sugar, 48J/A 
Videocassettes on patient education, 14D 

The Caned.." Nur.. 


BAJNOK, Irmajean 
Perspective. E, 6AP 

BANNING, Judith 
A personal commitment to fitness results 
in healthier clients, 38My 
How NOT to be a victim, 31Fe 

BARD, Rachel 
Awarded the Marjorie Hiscott Keyes 
Medal for 1979, 48Je 

BARR, Frances 
Are your students positive about their 
experience in the clinical area'? 480c 

BARRY, Laura 
Guillain Barré Syndrome, 26Mr 
BARRY, N. Patricia 
Appointed director of nursing of the 
Hamilton Psychiatric Hospital, 6N 

BEATON, Janet 
CNF Scholarship, 2S0c 
Man versus microbe: a case for the 
Infection Control Nurse (Ratsoy) 30D 
BECKER, Constance 
The postpartum period, 24D 
CNA Public Representative (port) 8D 
Tomorrow's nurses shape up for a healthy 
future (Friesen) 49Ap 

December 1810 83 

CNJ talks to Gordon Friesen, on the side 
of the angels, 4SJe 
Perspective, E, SJa, SFe, SJe 

Biofeedback-does it work'? (Burdis) 44Fe 

Bladder retraining (Whittington) 26Je 
BLAKER, Gloria 
Some of us are more equal than others, E, 
BLAU, June L. 
Bk. rev., S2Je 

New baby in the family, 420c 

Hemostasis and the nature of its defect in 
hemophilia (Hedlin) ISD 
BLUNDELL, Heather 
Awarded 1980 Judy Hill Memorial Fund 

BOCK, Jane 
Baffiegab-are we the next victims'? E, 6D 
Herpes: scourge of the seventies, 22J a 
Mirror, mirror on the wall, E, SMr 
Stroke: a review, 47My 
University programs for RN's, 36Ja 

S3Ja, S4Mr, SUe, 44D 
Abels, Linda Feiwell. Manual of critical 
care, 5 6J a 
Anthony, Catherine P. and Thibodeau, 
Gary A. Basic concepts in anatomy and 
physiology, a programmed 
presentation, S4J e 
Bates, Barbara. A guide to physical 
examination,S I D 
Bathea, Doris C. Introductory maternity 
nursing, S4Je 
Brooker, Andrew M.D. and Schmeisser, 
Gerhard Jr., M.D. Orthopedic traction 
Chenevert, Melodie. Special techniques in 
assertiveness training for women in the 
health professions, S3Ja 
Comoss, P., Burke, E. and Swails, S. 
Cardiac rehabilitation: a 
comprehensive nursing approach, 47D 
Current practice in critical care, 48D 
Diers, Donna. Research in nursing 
practice, SOD 
Dreyer, S. Guide to nursing management 
of psychiatric patients (Bailey, Doucet) 
Fotheringham, John B. and Morris, Joan. 
Helping the retarded child in the 
elementary school years, SOD 
Gutch, C.F. and Stoner, Martha H. Review 
of hemodialysis for nurses and dialysis 
personnel, SOD 
Hilt, Nancy and Cogburn, Shirley. Manual 
of orthopedics, 48D 
Hinchliff, S.M. ed. Teaching clinical 
nursing, S4Ja 
Hood, G. and Dincher, 1. Total patient 
care-foundations and practice, 48D 
Kolff, CorneJis and Sanchez, Ramon. 
Handbook of infectious diseases 
Ingalls, S. Joy and Salerno, M. Constance. 
Maternal and child nursing, 47D 
Lancaster, Jeanette. Community mental 
health nursing: an ecological 
perspective, 44D 
Lee, Eloise R. Concepts in basic nursing: a 
modular approach,S ID 
Litwack, Lawrence, Litwack, Janice M. 
and Ballou, Mary B. Health counseling, 
Marriner, Ann. The nursing process-a 
scientific approach to nursing care, 
Mason, Elizabeth J. How to write 
meaningful nursing standards, S8Ja 
McCormick, Rose-Marie Duda and 
Gilson-Parkevick, Tamar. Patient and 
family education: tools, techniques 
and theory, 44D 
Metheny, N. and Snively, W.D. ed. Nurses' 
handbook of fiuid balance, SSJe 
Mirin, Susan Kooperstein. Teaching 
tomorrow's nurse: a nurse educator 
reader, SOD 

14 December 1810 

Olds, London, Ladewig and Davidson. 
Obstetric nursing, 47D 
Pearson, L.J. and Kotthoff, M.E. Geriatric 
clinical protocols, 5 I D 
Pochedly, Carl. ed. Pediatric cancer 
therapy, SUe 
Riehl, Joan P. and Roy, Callista. 
Conceptual models for nursing 
practice, 48D 
Rozovosky, Lorne Elkin. The Canadian 
patient's book of rights, 45 D 
Schwartz, Jane Linker. ed. Vulnerable 
infants: a psychosocial dilemma 
(Schwartz) S8Ja 
Skillbook Series. Documenting patient 
care responsibly, 5 6J a 
St. John Ambulance. Emergency first aid, 
safety oriented, S6J a 
Wehrmaker, S. and Wintermeute, J. Case 
studies in neurological nursing, SUe 
Wilting, Jennie. People, patients and 
nurses: a guide for nurses toward 
improved interpersonal relationships, 

BOUCHARD, Jeannette 
Contract learning (SteelS) 44J a 
Adult respiratory distress syndrome,S IOc 
BRAMWELL, Lillian 
CNF Scholarship, 2S0c 
BRANDT, Shirley, L. 
Appointed director of continuing 
education in nursing at the School of 
Nursing, University of B.C., 48Je 

Breast disease in nurses, a 30-year study 
(Elwood, Hislop) 38D 
Nursing mothers - then and now 
(Wallace) 440c 
BURDlS, Cris 
Biofeedback-does it work'? 44Fe 

BURNS, Katharina A. 
Bk. rev., S4Je 
BURNS, Margaret 
Day care: the selective alternative for 
psoriasis patients (Schachter) 36Fe 
BURRY, Muriel 
Antidiuretic hormone and its inappropriate 
secretion (Martens) 41 Fe 


CAHOON, Dr. Margaret C. 
Appointed Rosenstadt Professor in Health 
Research in Faculty of Nursing at 
University of Toronto, 6N 

70Ja, 62Fe, llMr, 17Ap, SJ/A, 14S 
CALOREN, Heather 
Appointed Assistant Director-Nursing 
Service for the Elderly with the VON, 

CAMERON, Sheila 
Bk. rev., SOD 

CAMPBELL, Margaret A. 
CNA Ticket of Nominations (port) 24AP 

Putting "health" into health care, CNA 
brief promotes more use of nurses, 
CAUSN re(!istration over the 100 mark 
(Hilton) 22My 
The ups and downs of blood sugar, color 
poster, AV, 48J/A 
IV nurses exchange information, ideas, 

The Canedlan Nur.. 

A capsule history of your journal, 20Mr 

Annual meeting roundup, 6J/A 
CNA directors finish 1978-8Ó business, 
prepare for new biennium, 24S 
Meet your new executive! 22S 
News from the CNA boardroom, 8D 
The end of an era at CNA, Tribute to 
Helen K. Mussallem, 23S 

Public safety, professional excellence, 18S 

CNA directors approve nursing ethics 
code, 1980 budget and health services 
brief, 18My 
Putting "health" into health care, CNA 
brief promotes more use of nurses, 
Program highlights, 10Ap 
Ticket of Nominations 1980-82, 21Ap 

Development of a Definition of Nursing 
Practice and Standards for Nursing 
Practice, 11 My 

The integration syndrome (Rajabally) 42J a 
Ten Canadian nurses receive scholarships, 

CN F announces special scholarship, 9Mr 

Fun and fitness featured at orthopedic 
nurses' meeting, 22My 

Nurse heads CPHA, ISS 

Cardiac rehabilitation: applying the 
benefits of exercise (Naimark) 41Ap 
The stress test (MacFarlane) 39Ap 
Bk. rev., S6Ja 
CARVER, Joyce 
Shopping for audiovisuals, A V, 48J / A 

Breaking the cycle of abuse, 30N 

Health and Welfare issues warning, 14Je 

Perceptual disorders (Hart) 44My 
Stroke: a review (Bock) 47My 

CHATER, Kathy 
Dangerous equations, 23N 
Dealing with the disruptive patient, 26N 
The drug abusing patient in the ER, 28N 

Successful chemotherapy (Law) 19Fe 

Surgical tattooing (McKenzie) 26My 

Six nurse coordinators help international 
study, IlJe 
CLARKE, Heather 
CNF Scholarship, 2S0c 

CNA Code of Ethics: an ethical basis for 
nursing in Canada, My (insert) 

Development of a Definition of Nursing 
Practice and Standards for Nursing 
Practice, II My 

CNA's Task Group-a set of Principles 
for Standards, 14Ap 

COCHRANE, Elizabeth 
Awarded 1979 Judy Hill Memorial 
Scholarship, 10Ja 
Awarded 1980 Judy Hill Memorial 
Baffiegab-are we the next victims'? (Bock) 
Wanted! A new interface between 
administration, nursing and medical 
staff (Monaghan) 42D 
A postpartum prograrp that really works 
(Freeman) 40Mr 
Gasoline inhalation: a community 
challenge (Daubert, MacAdam) 24N 
The body shop (McMurray) 46Ap 
Locating nursing research data via 
computer (Zelmer) 14Je 
Nurses, doctors co-operate for closer look 
at critical care, 10D 
Public safety, professional excellence, 18S 
Third international seminar looks at death 
and dying, 10D 

Was the patient informed'? (Sklar) ISJe 
The body shop (McMurray) 46Ap 
COOPER, Linda 
CNF Scholarship, 2S0c 
CORMIER, Simone-Marie 
CNA Ticket of Nominations (port) 23Ap 
COWAN, Deborah 
Halo traction (York) 28Ja 
COWAN, M. Kathleen 
Bk. rev., 44D 

CRAWFORD, Myrtle E. 
CNA Ticket of Nominations (port) 23Ap 
Do as I say! 40Ja 

Nurses, doctors co-operate for closer look 
at critical care, 10D 

CROLL, Senator David A., Q.C. 
A geriatric crisis, E, 2J / A 

Checking out your own "cultural 
awareness" (O'Neill) 2SJe 
Transcultural nursing (Hodgson) 23Je 

Health around the world (Johnson) 48My 


Gasoline inhalation: a community 
challenge (MacAdam) 24N 
DA VIES, Elizabeth 
CNF Scholarship, 2S0c 
DEAS, Sister Anne 
Appointed director of nursing, St. Paul's 
Hospital, Saskatoon, 14Ja 

A time to be born, a time to die (Mciver) 
Third international seminar looks at death 
and dying, 10D 
DEGNER, Lesley 
CNF Scholarship, 2S0c 

The birth room (Rosen) 30Mr 

An open letter to the nurses of Canada 
(White) 33Mr 
DEVINE, Barbara 
The House of Respect, 41S 

HELP! (Yantzie) 33Je 
DOBSON, Karen 
A second chance, 37Je 

A health-oriented approach (Paech) E, 
It could happen to you! (Kolesar) 20N 
The drug abusing patient in the ER 
(Chater) 28N 
Use'? Or Abuse'? (Henderson) E, 19N 

A learning program in the addictions 
(McGee) 22N 
Breaking the cycle of abuse (Casselman) 
Dealing with the disruptive patient 
(Chater) 26N 
Primary nursing In the addictions 
(Fitzpatrick) 29N 
Dangerous equations (Chater) 23N 

A programmed learning package: Living 
and working with drugs (Gaerlan) 3SN 
Dangerous equations (Chater) 23N 
DR YSDALE, Arlene 
Awarded 1980 Judy Hill Memorial 
Fund Scholarship. 6N 
DURNFORD, Phyllis 
Bk. rev., SUe 


EADES, Margaret 
Bk. rev.. 48D 

EARLE, Margaret 
CNF Scholarship, 2S0c 
EATON, Connie 
Nursing care plans and the private duty 
home care patient, 2SJa 

EDGREN, Marilyn D. 
Bk. rev., 48D 

Established in memory of the late Edith 
Rainsford Dick, 14Ja 

Planners ready for continuing ed meeting, 

Are your students positive about their 
experience in the clinical area'? (Barr) 
Back to basics, Nursing educators face up 
to needs of the eighties, 16Ja 
Contract learning (Bouchard, Steels) 44J a 
Grading student nurses (Wood, Wladyka) 
The expanded role of the handmaiden 
(Logan) 34Ja 
University programs for RN's (Bock) 36Ja 
CAUSN re(!istration over the 100 mark 
(Hilton) 22My 
C.A.R.P. A new way to learn (Murray) 
Continuing ed challenge topic for national 
meet, ISS 

The Canedlen Nur.. 

University programs for RN's (Bock) 36Ja 

Health hotline makes house calls in 
Halifax, 220c 
ELLIS, Donelda 
Whatever happened to the spiritual 
dimension'? 42S 

ELWOOD, J. Mark, M.D. 
Breast disease in nurses, a 30-year study 
(Hislop) 38D 
Fire (Sq uires) 49S 
Accidental hypothermia: emergency 
rewarming techniques (Rae) 28Fe 

The drug abusing patient in the ER 
(Chater) 28N 
Income tax and the self-employed nurse 
(Garbutt) 3SJ/A 
The need to know'? 30My 

CNA directors approve nursing ethics 
code, 1980 budget and health services 
brief, 18My 
CNA Code of Ethics: an ethical basis for 
nursing in Canada, My (insert) 

Cardiac rehabilitation: applying the 
benefits of exercise (Naimark) 41Ap 
Exercise: how the body responds (Hedlin) 
The stress test (MacFarlane) 39Ap 

What's the score on sports and eye 
injuries'? (Moses) 43Ap 


FAWDRY, M. Kaye 
Bk. rev., SOD 

Awarded 1980 Judy Hill Memorial 
Fund Scholarship, 6N 

Letting go (Parrish) 34Mr 
FIELD, Peggy Anne 
CNA Ticket of Nominations (port) 26Ap 
Primary nursing in the addictions, 29N 

CNF Scholarship, 2S0c 
FORTIN, Fabienne 
CNA Ticket of Nominations (port) 27 Ap 

FREEMAN, Kathleen 
A postpartum program that reaily works, 

FRENCH, Eileen 
Bk. rev., SOD 
FRENCH, Susan 
Appointed associate dean, Health Sciences 
(Nursing) at McMaster University, 6N 
FRIESEN, Bonnie 
Tomorrow's nurses shape up for a healthy 
future (Bentley) 49Ap 
CNJ talks to Gordon Friesen, on the side 
of the angels (Besharah) 4SJe 
How NOT to be a victim (Banning) 31Fe 

December1810 15 


GAERLAN, Marylou 
A programmed learning package: living 
and working with drugs, 3SN 
Understanding the physiology of alcohol 
abuse, 46N 

HELP! (Yantzie) 33Je 

GARBUTT, Maureen 
Income tax and the self-employed nurse, 
Gasoline inhalation: a community 
challenge (Daubert, MacAdam) 24N 
The need to know'? 30My 

A geriatric crisis (Croll) E, 2J /A 
A self-help guide to the aging process 
(Morden) 19J/A 
Nurses look at new ways of helping 
'young old' and 'old old', ISAp 
Reality orientation (Nepom) 26J/A 
Seniors: A target for nutrition educatitm 
(Gillis) 28J/A 
The House of Respect (Devine) 40S 

Nurses look at new ways of helping 
'young old' and 'old old'. ISAp 
GILLIS, Doris 
Seniors: A target for nutrition education, 

G LASS, Helen 
Awarded YWCA Woman of the Year 
award for Education, 10Ja 
CNA Ticket of Nominations (port) 22Ap 
GLUA, Emma C. 
Bk. rev., S6Ja 

GOERTZ, Phyllis 
CNA Ticket of Nominations (port) 28Ap 
GRANT, Nancy 
Bk. rev., 48D 

GRASSET, Stephany 
Elected president of the RNABC, 14Ja 

Letting go (Parrish) 34Mr 


HANSON, Patricia Gaye 
Awarded 1980 Judy Hill Memorial Fund 

HARRIS, Janet B. 
Bk. rev., 47D 

HART, Geraldine 
Perceptual disorder, 44My 
HA YES, Marjorie W. 
Appointed director of the Health 
Computer Information Bureau, 48Je 

HA YNES, Barbara 
Institutionalization. What happens to 
patients in a long term treatment 
center, 43Mr 

Did you know, 14Ap 

Save your own life (Logan) SOAp 

Perspective (Besharah) E, SJe 
Transcultural nursing (Hodgson) 2 3J e 
Exercise: how the body responds, 30Ap 
Hemostasis and the nature of its defect in 
hemophilia, ISD 

II December 1980 

A special hemophilia program (O'Neill) 
Hemostasis and the nature of its defect in 
hemophilia (Hedlin) ISD 
Hemostasis and the nature of its defect in 
hemophilia (Hedlin) ISD 
Use'? Or Abuse'? E, 19N 

Hepatitis B: an occupational risk 
(Keck, Swerhun) 33D 
Herpes: scourge of the seventies 
(Bock) 22Ja 
Breast disease in nurses, a 30-year study 
(Elwood) 38D 
HOBDEN, Elizabeth 
Bk. rev., 48D 
HODGSON, Corinne 
Transcultural nursing, 23Je 

Won Deknatel Educational Award for 
Canada, 14Ja 

Nursing care plans and the private duty 
home care patient (Eaton) 2SJa 
Shirley-A success story (McNairn) 40D 
HOME, Elfriede 
Bk. rev., 4SD 

Help is as close as the phone, 13D 

Hospitals and nurses: the evolution of 
legal responsibility (Sklar) SOM y 

Health hotline makes house calls in 
Halifax (Ellerton) 220c 
Six nurse coordinators help international 
study, llJ e 

Accidental hypothermia: emergency 
rewarming techniques (Rae) 28Fe 
Controlled hypothermia: a treatment for 
an acute anoxic incident (Thomas) 
How NOT to be a victim (Banning) 31Fe 
Hypothermia and the senior citizen, 33Fe 

Antidiuretic hormone and its 
inappropriate secretion 
(Burry, Martens) 41 Fe 

Income tax and the self-employed nurse 
(Garbutt) 3SJ/A 
Perspective (Besharah) E, SJe 
Self-help groups for parents of premature 
infants (Shosenberg) 30J/A 
Man versus microbe: a case for the 
Infection Control Nurse 
(Ratsoy, Beaufoy) 30D 
Help is as close as the phone, 13D 

13Fe, 6Mr, 8My, 7Je, lOS, 60c, 69N 

The C.ned"n Nur.. 

C.A.R.P. A new way to learn (Murray) 

Institutionalization. What happens to 
patients in a long term treatment 
center (Haynes) 43Mr 

The extension of hospital liability (Sklar) 

Enterostomal therapists hold Canadian 
meeting, 10Ja 

ICN sets Congress fees, ISS 


JACK, Susanna 
Bk. rev., 44D 

Baffiegab-are we the next victims'? (Bock) 
Wanted! A new interface between 
administration, nursing and medical 
staff (Monaghan) 42D 
JOHNSON, Maureen 
Health around the world, 48My 

Awarded to II nurses, 6N 


KAM, Simon 
Bk. rev., 48D 

KECK, Jean 
Hepatitis B: an occupational risk 
(Swerhun) 33D 
Nutritionists share findings on diet and 

KERMER, Gisele Fontaine 
Denial, 43S 

KOLESAR, Gregory 
AWS: recognition and rehabilitation 
(Shaw) 49N 
It could happen to you! 20N 
Awarded 1980 Judy Hill Memorial Fund 


LABARGE, Margaret 
CNA Public Representative (port) 8D 

Nurses unions, professional associations 
and YOU (Rowsell) 
Part one: Nurses take the union route, 
Part two: The role of the nurse-manager in 
labor relations, 30S 

Increased intracranial pressure: when 
assessment counts, 340c 

LALIBERTE, Marie-Therese 
Awarded Warner-Lambert Canada Ltd. 
nursing fellowship, I OJ a 
LANDRY, Teresa 
Awarded 1980 Judy Hill Memorial Fund 
LAPP, Cheryl Ann 
Bk. rev., S6Ja 

LAROSE, Odile 
CNA Ticket of Nominations (port) 27Ap 

LAW, Diana 
A developing framework for oncology 
nursing (Price) 44S 
Successful chemotherapy, 19Fe 

LEBLANC, Antoinette 
Bk. rev., SSJe 
Received United Nurses Award of Merit, 
Legionnaire's disease. An old enemy with 
a new name (Schilder) 46Mr 
Hospitals and nurses: the evolution of 
legal responsibility (Sklar) SOMy 
"Nurse, you did this to me!" (Sklar) ION 
Student nurses and the law (Sklar) 70c 
The responsibility of the patient (Sklar) 
The integration syndrome (Rajabally) 42Ja 
Canadian nurses to write CGFNS exams to 
work in U.S., 16Fe 

Perspective (Bajnok) E, 6Ap 
The body shop (McMurray) 46Ap 
Awarded 1980 Judy Hill Memorial Fund 

The expanded role of the handmaiden, 34Ja 
LOGAN, Marion 
Save your own life, SOAp 

A second chance (Dobson) 37Je 

Maria Zinck wins 3M scholarship, IlJe 

Gasoline inhalation: a community 
challenge (Daubert) 24N 
The stress test, 39Ap 

Awarded 1980 Judy Hill Memorial Fund 
Scholarship, 6N 
Nerve palsies: the preventable sort 
e) 38J/A 
MACLEOD, Shirley 
Bk. rev., 47D 

Fitting nursing into fitness, 33Ap 

Malignant hyperthermia need not be 
lethal (Noble) 33S 
Hospitals and nurses: the evolution of 
legal responsibility (Sklar) SOMy 
The extension of hospital liability (Sklar) 

Annual meeting roundup, 7J/A 
Antidiuretic hormone and its 
inappropriate secretion (Burry) 41Fe 

A postpartum program that really works 
(Freeman) 40Mr 
Six steps to better bonding (Rhone) 380c 
MA Y, Thelma Jane 
Appointed director, Nursing Service at 
Bloorview Children's Hospital, 
Toronto, 14Ja 

MA Y, Thelma R. 
The light still shines in EIora (May) 42My 

MAY, Wendy J. 
The light sti11 shines in Elora (May) 42My 
MCEWEN, Janet 
An employee fitness program, 36Ap 
MCGEE, Arlee D. 
A learning program in the addictions, 22N 
MCGEE, Marian 
CNA Ticket of Nominations (port) 27Ap 
Nursing in a university health service 
(Tracy) 40Je 
A time to be born, a time to die, 38S 

Surgical tattooing (Chung) 26My 
MCMURRAY, Anne Esler 
The body shop, 46Ap 
MCNAIRN, Noreen 
Shirley-A success story, 40D 
MCNAMEE, Christine 
Nerve palsies: the preventable sort 
(Maclean) 38J/A 
MCPHAIL, Irene Ross 
Elected president of St. John Ambulance 
Federal District Council, ISJa 

Co-winner of Frances MacDonald Moss 
Scholarship, l4J a 

Health happenings, 16Fe 

Consent, sterilization and mental 
incompetence: the case of "Eve" 
(Sklar) 14Mr 
CNA Public Representative (port) 8D 
MILLS, Karen 
Appointed director of nursing of 
Edmonton Local Board of Health, 6N 
MONAGHAN, Gabrielle 
Wanted! A new interface between 
administration, nursing and medical 
staff, 42N 
MOORE, Janet 1.. 
Bk. rev., S3Ja 
MORDEN, Patricia 
A self-help guide to the aging process, 
Bk. rev., SID 

MOSES, Susan 
What's the score on sports and eye 
injuries? 43Ap 

Appointed vice-president, Nursing at 
Vancouver General Hospital, 14Ja 
CNA Ticket of Nominations (port) 24Ap 
MURRA Y, Margaret E. 
C.A.R.P. A new way to learn, 42Je 

A surprise presentation (port) 8D 
CNA executive director addresses "nurses 
in the marketplace", 8Ja 
The end of an era at CNA, 23S 


14Ja, 48Je, 6N 
CNA directors ready for 1980, Health 
Minister fields questions, 7Ja 

US, Canadian nurses attend perinatal 
symposium, 140c 

A developing framework for oncology 
nursing (Law, Price) 44S 

The C.nedl.n Nur.. 

NEPOM, Rosalie 
Reality orientation (Walker) 26J/A 
Nerve palsies: the preventable sort 
(McNamee, Maclean) 38J/A 
Nurses in the news, 10Ja 

6Ja, 16Fe, 9Mr, 14Ap, 22My, IlJe, 6J/A, 
ISS, 140c, 8D 
NEYLAN, Margaret S. 
Admitted as a Servicing Sister of the Most 
Venerable Order of the Hospital of 
St. John of Jerusalem, 48Je 

The light still shines in Elora, (May, May) 
NOBLE, Elizabeth 
Malignant hyperthermia need not be 
lethal, 33S 
NOLAN, Eleanor 
Awarded 1979 Judy Hill Memorial 
Scholarship, 10Ja 
Awarded 1980 Judy Hill Memorial 
Scholarship, 6N 

Nurse administrators hold first national 
conference, ISS 

Are your students positive about their 
experience in the clinical area'? (Barr) 
Dealing with the disruptive patient 
(Chater) 26N 
Do as I say! (Cristall) 40J a 
Guillain Barré Syndrome (Barry) 26Mr 
Successful chemotherapy (Law) 19Fe 
A little crystal ball gazing, 24Mr 
It could happen to you! (Kolesar) 20N 
Mirror, mirror on the wa11 (Bock) E, SMr 

Perspective (Besharah) E, SJe 
Nursing audit. What's it all about'? (Sultan) 
A special hemophilia program (O'Neill) 
An open letter to the nurses of Canada 
(White) 33Mr 
Perspective (Besharah) E, SFe 
The postpartum period (Becker) 24D 

The House of Respect (Devine) 40S 
Locating nursing research data .via 
computer (Zelmer) 14Je 
Development of a Definition of Nursing 
Practice and Standards for Nursing 
Practice, llMy 
Standards group, 16Fe 

Nurse administrators conference, 14Je 
Nurse administrators hold first national 

Nutritionists share findings on diet and 
Seniors: A target for nutrition education 
(Gillis) 28J/A 


The Birth Room (Rosen) 30Mr 
When experience counts (Segal) 38Mr 

December1810 87 

CNA executive director addresses "nurses 
in the marketplace", 8Ja 
Occupational health nurses urged to take 
aggressive stand, 12 D 

O'NEILL, Gail 
A special hemophilia program, 18D 
Checking out your own "cultural 

Occupational health nurses receive 
$95,000, 10Mr 
Prevention pays, PHN tells committee, 

CNA directors ready for 1980, Health 
Minister fields questions, 7 Ja 

Québec nurses pay tribute to children 
round the world, 6J a 

Wanted! A new interface between 
administration, nursing and medical 
staff (Monaghan) 42D 
Halo traction (York, Cowan) 28Ja 


PAECH, Gail 
A health-oriented approach, E, 18N 

New baby in the family (Bliss) 420c 
Self-help groups for parents of premature 
infants (Shosenberg) 30J/A 
Six steps t
 better bonding (Rhone) 380c 
Shirley-A success story (McNairn) 40D 
PARRISH, Sheila 
Letting go, 34Mr 

CNA's Director of Testing Service 
responds, 43J a 

"Nurse, you did this to me!" (Sklar) ION 

Institutionalization. What happens to 
patients in a long term treatment 
center (Haynes) 43Mr 
Do as I say! (Cristall) 40Ja 
Was the patient informed'? (Sklar) 18Je 
The responsibility of the patient (Sklar) 
The responsibility of the patient (Sklar) 
Bk. rev., S4Je 

Bk. rev., S8Ja 

US, Canadian nurses attend perinatal 

Nerve palsies: the preventable sort 
(McNamee, Maclean) 38J/A 
PERRIN, Joyce 
Appointed administrator of Bloorview 
Children's Hospital, Toronto, ISJa 

II December 1980 

SJa, SFe, SMr, 6Ap, 6My, SJe, 2J/A, 6S, 
18N, 19N, 6D 
A personal commitment to fitness results 
in healthier clients (Banninj!) 38My 
An employee fitness program (McEwen) 
Fitting nursing into fitness (Macnamara) 
Fun and fitness featured at orthopedic 
nurses' meeting, 22My 
Perspective (Bajnok) E, 6Ap 
Tomorrow's nurses shape up for a healthy 
future (Bentley, Friesen) 49Ap 
PICK, Jeanette 
Honored last Fall, 10Ja 

Denial (Kermer) 43S 
Guillain Barré Syndrome (Barry) 26Mr 
PRICE, Barbara 
A developing framework for oncology 
nursing (Law) 44S 

Primary nursing (Roberts) 20D 
Primary nursing in the addictions 
(Fitzpatrick) 29N 
PROULX, Lissa Jane 
Bk. rev., SID 

Day care: the selective alternative for 
psoriasis patients (Burns, Schachter) 
You're in hospital with what'? (Steen) 34Fe 
The postpartum period (Becker) 24D 

Nursing care plans and the private duty 
home care patient (Eaton) 2SJa 


RACINE, Barbara A. 
Appointed administrator of the Inpatient 
Division and Director of Nursing of the 
Alberta Children's Hospital in Calgary, 

A race against time: caring for a patient 
with radiation enteritis (Ronayne) 38Fe 
RAE, Donna 
Accidental hypothermia: emergency 
rewarming techniques, 28Fe 

RAJABALLY, Mohamed H. 
The integration syndrome, 42Ja 

RA TSOY, M. Bernadet 
Man versus microbe: a case for the 
Infection Control Nurse (Beaufoy) 
Reality orientation (Nepom) 26J/A 
Annual meeting roundup, 6J/A 

Annual meeting roundup, 10J/A 

Annual meeting roundup, 9J/A 

Whatever happened to the spiritual 
dimension? (Ellis) 42S 

The C.nadlan Nur.. 

S2Ja, SOJe, S6N 
A research report on the development and 
validation of the PCTC System (Bay) 
An empirical investigation of the 
relationship between nurse's level of 
self-actualization and ability to develop 
positive helping relationships with 
hospitalized patients (Logan) S6N 
Assimilative and accommodative responses 
of mothers to their newborn infants 
with congenital defects (Kikuchi) SOJe 
Child rearing concerns of first time 
mothers (Kirkwood) S6N 
Commitment to the nursing profession: an 
exploration of factors which may 
explain its variability (Flannery) S6N 
Development and validation of 
information needs inventory (MI 
patient) (Lamb, Payne, Thorpe) 4SN 
Factors influencing dietary adherence as 
perceived by patients on long-term 
peritoneal dialysis (Hum e) S6N 
Familial strain and the development of 
normal and handicapped children in 
single and two parent families (Burke) 
Health-related problems of elderly people 
attending senior citizen clubs/centers 
(Milton) S2Ja 
H.E.L.P. Health evaluation and lifestyle 
promotion (Yeo) S6N 
Knowledge of prescribed medical regime, 
concerns and unanswered questions 
reported by wives of aortocoronary 
bypass patients in early convalescence 
(Sikorski) 5 OJ e 
Problems of the independent elderly in 
using the telephone to seek health care 
(Caloren) SOJe 
Punishing the pregnant innocents. Single 
pregnancy in St. John's, Newfoundland 
(Toumishey) S2Ja 
Self-actualization in retirement (Kingston) 
The development of health sciences 
education programs in metropolitan 
Toronto Region Colleges of Applied 
Arts and Technology, 1967-1977; a 
study of selected factors infiuencing 
this development (Peszat) S6N 
The effects of two types of fetal 
monitoring on ability to maintain 
control during labor (Hodnett) S6N 
The relation of constraint and situational 
theory to diploma nursing program 
leadership (Goldenberg) S6N 
The use of written simulations to measure 
problem solving skills of nursing 
students (Munro) SOJe 

A practical goal for the 80's, (Allen, Slater) 

A second chance (Dobson) 37Je 
Adult respiratory distress syndrome 
(Bourbonnais) 5 IOc 
RHONE, Margaret 
Six steps to better bonding, 380c 

RICE, J. Alison 
Bk. rev., S8Ja 

Appointed professor of nursing and dean 
of the College of Nursing at the 
University of Saskatchewan, 48Je 

ROACH, Sister Marie Simone 
CNA Ticket of Nominations (port) 2SAp 
ROBBINS, Marilyn 
Bk. rev., S3Ja 

Appointed nursing consultant-Practice 
with ARNN, ISJa 
ROBERTS, Laverne E. 
Primary nursing, 20D 

ROBSON, Beverley Ann 
Awarded 1980 Judy Hill Memorial Fund 
Scholarship, 6N 
CNF Scholarship, 2S0c 

RODGER, Ginette 
Appointed to position of executive 
director (port) 2SS 
CNA Ticket of Nominations (port) 24Ap 
Elected vice president of Board of 
Directors of the Canadian Council on 
Hospital Accreditation for 1980-81, 6N 
RONAYNE, Roberta 
A race against time: caring for a patient 
with radiation enteritis, 38 Fe 

ROSE, Jean 
Appointed nursing consultant-Education 
with ARNN, 14Ja 
ROSEN, Ellen L. 
The Birth Room, 30Mr 
ROSS, Sheila 
Co-winner of Frances MacDonald Moss 
Scholarship, 14Ja 
CNA Ticket of Nominations (port) 23Ap 
ROWSELL, Glenna 
Nurses unions, professional associations 
and YOU 
Part one: Nurses take the union route, 
Part two: The role of the nurse-manager in 
labor relations, 30S 


SANDERS, Marvel Miller 
Stressed'? Or Burnt Out'? 300c 

Annual meeting roundup, 8J/A 
Day care: the selective alternative for 
psoriasis patients (Burns) 36 Fe 
Legionnaire's disease. An old enemy with 
a new name, 46Mr 

Ten Canadian nurses receive scholarships, 
SCHOLDRA, Dr. Joanne 
Appointed director of University of 
Lethbridge School of Nursing, 48Je 
The need to know'? 30My 
SEGAL, Sylvia 
When experience counts, 38Mr 

Some of us are more equal than others 
(Blaker) E, 6My 
SHAW, Joanne M. 
AWS: recognition and rehabilitation 
(Kolesar) 49N 
Adult respiratory distress syndrome 
(Bourbonnais) SlOe 
Self-help groups for parents of premature 
New baby in the family (Bliss) 420c 
SKLAR, Corinne 
Consent, sterilization and mental 
incompetence: the case of "Eve", 
Hospitals and nurses: the evolution of 
legal responsibility, SOMy 
"Nurse, you did this to me!" ION 
Student nurses and the law, 70c - 
The extension of hospital liability , 8Fe 
The responsibility of the patient, 14J/A 
Was the patient informed'? 18Je 

Increased intracranial Eressure: when 
assessment counts (Ladyshewsky) 340c 
SLATER, Myrna 
A practical goal for the 8 )'s (Allen) E, 6S 

A geriatric crisis (Croll) E, 2J/A 
What's the score on sports and eye 
Injuries'? (Moses) 43Ap 
Fire, 49S 
ST ANOJEVIC, Patricia S.B. 
CNA Ticket of Nominations (port) 25Ap 
STANTON, Sheila 
Bk. rev., SOD 

STEED, Margaret 
Appointed associate dean of the faculty of 
nursing, University of Alberta, 6N 
CNA Ticket of Nominations (port) 26Ap 
STEELS, Marilyn 
Contract learning (Bouchard) 44Ja 
STEEN, Maureen 
You're in hospital with what'? 34Fe 

Consent, sterilization and mental 
incompetence: the case of "Eve" 
(Sklar) 14Mr 
STINSON, Shirley M. 
CNA Ticket of Nominations (port) 22Ap 
STOBIE, M. Michele 
Bk. rev., SID 

Care for the caregiver (Vachon) 280c 
Stressed? Or Burnt Out? (Sanders) 300c 
The stress test (Mac Farlane) 39 Ap 
Nursing in a university health service 
(Tracy) 40Je 
Student nurses and the law (Sklar) 70c 
SULTAN, Shirley 
Nursing audit. What's it all about? 33My 

A race against time: caring for a patient 
with radiation enteritis (Ronayne) 38 Fe 
Surgical tattooing (Chung, McKenzie) 
Hepatitis B: an occupational risk (Keck) 


Surgical tattooing (Chung, McKenzie) 
A self-help guide to the aging process 
(Morden) 19J/A 
A time to be born, a time to die, (McIver) 
Third international seminar looks at death 
and dying, 10D 
THOMAS, Margot 
Controlled hypothermia: a treatment for 
an acute anoxic incident, 24Fe 

THORNE, Anne D. 
Bk. rev., 4SD 

Halo traction (York, Cowan) 28Ja 
TRACY, Florence 
Nursing in a university health service, 40Je 

Is there a move in your future'? 
(Worthington) 32Ja 

The c..nedlan Nur.. 

VACHON, Mary L.S. 
Care for the caregiver, 280c 

Herl'es: scourge of the seventies 
(Bock) 22Ja 
The Birth Room (Rosen) 30Mr 
Virus: pirate in the body, 24Ja 
When experience counts (Segal) 3SMr 


WALKER, Marion 
Reality orientation (Nepom) 26J/A 
Nursing mothers - then and now, 440c 

WEBER, Kirsten 
Bk. rev., 44D 
Nurse-midwives solicit members, 10Mr 
WHITE, Jane Melvilie 
An open letter to the nurses of Canada, 
Bladder retraIning, 26J e 
WILTSE, Marcia 
Bk. rev., SOD 

WLADYKA, Joanne 
Grading student nurses (Wood) 30Je 
WONG, Shirley 
Bk. rev., 54Je 
WOOD, Vivian 
Grading student nurses (Wladyka) 30Je 
Is there a move in your future'? 32Ja 

WRIGHT, Margaret Scott 
Appointed dean of nursing at University 
of Calgary, IsJa 


HELP! 33Je 
YORK, Nelly 
Halo traction (Cowan) 28Ja 
8Fe, 14Mr, SOMy, 18Je, 14J/A, 70c, ION 
YOUNG, Kathleen 
Bk. rev., S4Ja 

Appointed vice-president (Nursing) for the 
University of Alberta Hospitals, 6N 
Bk. rev., 47D 
ZELMER, Dr. Amy 
Appointed associate vice-president 
(academic) of the University of 
Alberta, 48J e 

ZINCK, Maria 
Maria Zinck wins 3M scholarship, IlJe 

December 1810 I' 

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Your patients are 
making it part of their life. 

W hen you feel a patient should cut 
down on saturated fats and watch his 
cholesterol intake. you probably recommend 
Fleischmann's 100% Corn Oil Margarine- 
and perhaps Egg Beaters, too. 
You may also suggest more fresh air and 
exercise as part of a general fitness program. 
Fleischmann's margarine, salted or 
unsalted. contains no cholesterol. Its high 
liquid corn oil content gives It an excellent 
polyunsaturated/saturated fats ratio. The 
natural ability of corn oil to inhibit serum 
cholesterol makes Fleischmann's margarine 
well worth recommending. 
What about compliance? Are your 
patients taking your advice? 


Yes. Canadians are getting out and 
exercising like never before. And they're 
becoming much more diet conscious. As a 
result, health concerned Canadians have 
made Fleischmann's their No. 1 margarine. 
And here's a fact that bears thinking 
about: the overall CV death rate for reople 
under 65 is down b y 27% since 1953. * 
W h atever Cana d ians are doing, they are 
doing somethin g right. So it makes sense to 
continue with the same good advice and 
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."Heart Facts & Figures" CanadIan Heart Foundation. 

100"10 Corn Oil Marganne and Egg Beaters 


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. Up the career ladder: your 
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. Herpes simplex, scourge of the 
. Home care my way, a plan for 
private duty nurses 
. Moving south? Tips on what to 


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Style No. 44412 - Dress 
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Anne Besharah 

Assistant Editors 
Judith Banning 
Jane Bock 

Production Assi
Gita Dean 

Circulation Manager 
Pierrette Hotte 

Advertising Manager 
Gerry Kavanaugh 

CNA Executi"e Director 
Helen K. Mussallem 

Editorial Advlson 

Mathilde Bazinet. chairman. Health 
Sciences Department. Canadore 
College. North Bay. Ontario. 

Dorothy Miller,public relarions 
officer. Registered Nurses Association 
of Nova Scotia. 

Jerry Miller, director of 
communicarion sen'ices, Registered 
Nurses Association of Britisn 



Jean Passmore. editor. SRNA news 
bulletin. Registered Nurses 
Association of Saskatchewan. 


Peter Smith, direcror of publicarions. 
National Gallery of Canada. 


Florita ViaJle-Soubranne. consulrant, 
professional inspection division. Order 
of Nurses of Quebec. 

Subscription Rates: Canada: one year, 
510.00: two years, 518.00. Foreign: 
one year. 512.00: two years, 522.00. 
Single copies: 51.50 each. Make 
cheques or I1IOney orders payable to 
the Canadian Nurses Association. 

Chanlcof A4:lress: Notice should be 
liven on advance. Include previous 
address as well as new. along with 
reglSuaUon-aumber, in a 
provincial/territorial nurses 
association where applicable. Not 
responsible for journals lost in mail due 
to errors in address. 

Canadian Nurses Association, 50 The 
Driveway, Ottawa, Canada. K2P lE2. 

Gel read
, get set, GO 
Vancouver. just in time for 
CNA's annual meeting next 
June. Our cover photo of the 
Vancouver skyline is counesy 
of Beautiful British Columbia 
Magazine. published quanerly 
by The Ministry of Tourism 
and Small Business 
Developmenl. Government of 
B.C.. who kindly supplied the 


January 1980 Volume 76. Number I 
The official journal of the Canadian Nurses Association 
published in French and English editions eleven times per 




. I 
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, -' 
)\ (1 . " 
, L.:..l 


Herpes ................. ..22 

Halo traction. . . . . . . . . . . . . .28 

16 Back to basics. nursing educators face 34 The expanded role of the handmaiden 
up to needs of the eighties Jo Logan 
Special Report 
22 Herpes: Scourge of the Se\enties 36 t:'niversit) programs for R"I's , 
Jane Bock Jane Bock 
25 Nursing care plans and the private duty 40 Do as I sa)! 
home care patient Brian Criswll 
Connie Eaton 
28 Halo traction 42 The Integration Syndrome 
Nelly York and Deborah Cowan Mohamed H. Rajabally 
32 Is there a move in your future? 44 Contract learning: the experience of two 
Laura Worthington nursing schools 
Jeannette Bouchard and 
Marilyn Steels 
6 News 14 Names 53 Books 
12 CNA moves West 50 Audiovisual 70 Calendar 
Get ready-get set-Go 
52 Research 

The Canadian Nurse welcomes suggestions for articles 
or unsolicited manuscripts. Authors may submit 
finished articles or a summary of the proposed 
content. Manuscripts should be typed double-spaced. 
Send original and carbon. All articles must be 
submitted for the exclusive use of The Canadian 
Nurse. A biographical statement and return address 
should accompany all manuscripts.. 

ISSN 0008-4581 

Indexed in International Nursing Index. Cumulative 
Index to Nursing Literature. Abstracts of Hospital 
Management Studies. Hospital Literature Index, 
Hospital Abstracts, Index Medicus. Canadian 
Periodical Index. The Canadian Nurse is available in 
microform from Xerox University Micromms. Ann 
Arbor, Michigan 48106. 

The views expressed in the articles are those of the 
authors and do not necessarily represent the policies of 
the Canadian Nurses Association. 

@Canadian Nurses Association. 1980. 


., , I 
I , · 

Why change dressings 
several times a day 
when once a week is plenty1 

This is an Op-site dressing for non-infected ulcers. 
When it goes on, it stays on... for a whole week. 
Because Op-site is an adhesive, transparent dressing 
that breathes and sweats with the skin. So you can keep 
your eye on the entire healing process without the 
interruptions of frequent dressing changes. 
Op-site is easy on the patient too. It's neat, not bulky. 
Patients can take regular baths or showers without 
discomfort because Op-site is water-proof. Op-site is 
also bacteria-proof, protecting the ulcer from 
Because once a week is plenty, Op-site means fewer 
dressing changes. And that's less work and more time 
for you. 

I 0 P -Site,"i) For f';Jrther informa!ion 
l>I?ut I I 
I Op-s.te ulcer dressing, fin In 
I the ultimate wound dressing and mail this coupon. I 
I Name I 

 Address I 
I I 
I City Prov._Code I 
I Mail to' 8] ,-- '-. Smith f, Nephew Inc. 2100. 52nd Avenue I 
. : S"I: Medicel Division Lachine. Qu
.. Cenede I 
I ". ..' H8T2Y5 

It is November. The streets of 
Montreal are beginning to fill 
with homeward bound 
commuters as I leave them 
behind. A., the bu.. hisses 
through the rain along the four 
lane highway linking Montreal 
to Ottawa. lights from farms 
along the way shine out of the 
The meeting I have just 
left is the fourth provincial 
annual meeting that I have 
attended in the past six 
months. I am thinking about 
the comment of the nurse who 
sat beside me at today's 
luncheon and remarked on 
how lucky I was to have the 
chance to visit all of these 
different provinces. I think of 
meetings over the last five 
years in Toronto. in 
Vancouver. in Regina. in 
Winnipeg, in Edmonton, in St. 
John's -from Kelowna. B.C. 
to Bridgewater. N .5. 


Collaboration is the lifeblood 
of every magaz ine. This is 
particularly the case when 
that journal is intended to 
reflect what is going on in a 
profession like nursing. 
These days, most oflhe 
manuscripts that cross the 
editor's desk bear the 
hallmarks, not just of good 
intentions, but also of creative 
and innovative thinking, 
conscientious effort and 
considerable skill and 
ingenuity in putting it all 
Nurses are using the 
written word to share their 
experiences with their 
colleagues. This sharing does 
not always have to be 
confined to words, however. 
Are you an amateur 
photographer looking for a 
new vehicle to display your 
talents? Are you a nurse 
whose most exciting camera 




I think of the nurses I 
have met and talked with at 
these meetings - nurses who 
care arout their profession, 
care about their colleagues. 
nurses who are willing to give 
up some oflheir precious free 

shots are ones that emphasize 
the caring a..pect of health 
Ifso, we'd like to see 
some samples of your work, 
with a view to sharing with 
other nurses the moments 
you've captured. The 
Canadian Nurse is looking for 
high quality color negatives or 
prints that might be featured 
on the cover, as well as good 
black and white prints for 
possible inside illustrations. 
Enquiries should be directed 
to The Editor, The Canadian 
Nurse, 50The Driveway, 
Ottawa, Ontario, K:!P I E2. 

Did you kno
There are 10 hospitals in Canada 
thai have incorporated Friesen 
concepts in their designs. Gordon 
Friesen, a London. Ontario health 
cORsultant, believes hospitals 
should be 'supennaIkets' of health. 
and emphasize preventive care first, 
curative care second. One hundred 
and fifty hospitals around the world 
have used some of Friesen's ideas, 
one of which is that doctors' offices 
should always be inside a hospital 
to save duplication of health records 
and doctors' travelling time. 

time to work for goals as 
intangible and elusive as the 
ones their professional 
associations have adopted. 
These are nurses working with 
other nur..es to promote 
higher standards of nursing 
practice so that people in this 
country can have better 
nursing care. Nurses whose 
aim it is to make sure that the 
educational programs 
available to nursing students 
and to graduates who want to 
add to their skills and 
knowledge are the best that 
can be offered. Nurses who 
are trying to find ways of 
helping other nurses to 
understand. support and 
encourage each other. Nurses 
who are willing to speak out 
on behalf of their colleagues at 
all kinds of meetings here in 
this country and abroad. 
I think of the nurses at the 
national and provincial level 

If Winter comes, can Spring be 
far behind? Maybe your 
reflections about the weather 
outside, the stflte of the 
economy or your attempts to 
finance a trip to warmer 
climes, leave you somewhat 
depressed. Well, cheer up, 
CNJ has some goodies in store 
for you that can't help but 
make 1980 a better year. 
For starters, flip through 
this January issue to find out 
what's new and exciting on 
the education front. We've got 
news of the first ever national 
nursing education conference 
in Ottawa last November. We 
have some tips for nurses 
considering the job scene 
south of the border. And 
we've got a useful list of 
what's available at Canadian 
universities for RN's who 
want to upgrade their 
education credits. 
Next month, you can 
look forward to a fine 
selection of clinical nursing 
articles on Legionnaire's 
Disease, Hypothermia, 
Psoriasis and Antidiuretic 
Hormone, among others. 

The Cenadlen Nur.. 

who put these goab ahead of 
personal needs and desires ..0 
that they can run for office. I 
think ofthe members of 
boards and committees who 
ask questions, read, study and 
travel in order to make a 
success of thei r particular 
project. I think of members 
who turn out faithfully for 
chapter meetings on nights 
when the roads are bad or 
they are tired after a 
particularly demanding shift. 
I realize that these nurses 
are unusual: commitment at 
this level is a rare and special 
thing. And I think, yes, I am 
lucky to have the chance to 
get to know these nurses. 
And, what is more important. 
their colleagues and their 
clients are lucky that nurses 
like these exist and that they 
still care. 

Photo by Studio Impact 


Then, in March, help us 
celebrate CNJ's 75th 
anniversary - three score 
years and fifteen of providing 
Canadian nurses with the 
latest in nursing news. 

, .... 


" 1\\' " 


I n April. CNJ marches to 
the tune of the health 
enthusiasts with a special 
fitness and lifestyle issuf>. This 
one promises to be a 
collector's item: it's a lifestyle 
approach that's tailored to 
your unique needs and 
interests as a member of one 
oflhe health-giving 
professions - nursing. 

Jenuary 1980 5 


Québec nurses pay tribute to children 
round the world 

Choosing the central theme of 
a tribute to the International 
Year of the Child, the Ordre 
des infirmières et infirmiers du 
Québec held their annual 
meeting in Montréallast 
November. In an opening 
ceremony attended by some 
1000 nurses, 80 Montréal 
schoolchildren, each carrying 
a flag representing the country 
of his national origin. were 
introduced to symbolize 
children everywhere. The 
guest of honor was Dr. 
Estafanis Aldaba-Lim, 
assistant secretary general of 
the UN and special 
representati ve for the Year of 
the Child. 

- .... 


 'S 41 "'
" , 
.. C 
<.. \' 

With IYC nearly over, 
Dr. Lim focused her attention 
on the work that had been 
done during the past year but 
she emphasized that the spirit 
ofIYC must not be allowed to 
die, the work must carryon. 

She called upon the nurses of 
Canada to continue their role 
of commitment, cooperation 
and leadership to ensure the 
well-being of children. 
Following Dr. Lim's 
speech, Nicole David, clinical 
nurse specialist in pediatrics 
at Maisonneuve-Rosemont 
Hospital, gave a presentation 
on one aspect of the nurse's 
role in the community, dealing 
with the problem of child 
abuse. She said that the 
problem is much larger than it 
appears: the awesome 
statistics of maltreated 
children represent only the 
cases that are reported, not 
the actual number. She said 
that nurses must examine 
closely the kind of parent 
model they are propagating in 
their practice. The nurse's 
role in the prel'ention of child 
abuse cannot be ignored 
either, she said: problems can 
be picked up even in prenatal 
classes and in the immediate 
perinatal period, as well as 
later in a child's life at home, 
in schools or clinics. 
Two other presentations 
were of interest: Robert Gary, 
a specialist in Asian life, 
discussed the Chinese outlook 
on health care, and Michel 
Roy, editor of Le Devoir, 
spoke on the image of the 
nurse in the media. 

It ... 

t .. 
, k 

6 J.nuery 11160 

-- .. 




During the conference, 
Québec nursing delegates 
passed a vote to raise their 
membership fees by $57, 
bringing the total fee for 1980 
to $147. Some delegates had 
promised their sections that 
they would not favor an 
increase, but they recognized 
that the OIIQ was in a difficult 
financial situation with an 
accumulated deficit of 
Other proposals included 
the request that the Order's 
publication Nursing Québec 
take a more active role in 
providing information to 
members. Delegates asked too 
that the Order reinforce its 
liaison role, and apply 
pressure in the university 
setting to contribute to iss ues 
of nursing education. It was 
proposed also that the 
contribution ofQuébec nurses 
to the CNA be proportional to 
the number of nurses in other 

Of particular interest to many 
delegates was the presentation 
of a report by Secor I nc., 
commissioned by the OIIQ to 
research the Québec nurses' 
self image. A representative of 
the firm, a Montréal-based 
organizational consulting 
company, cautioned nurses 
against interpreting the report 
too negatively. The basic 
conclusion, after analyzing 







ThA r...na".A'" Nllr.. 

the results of a mail 
questionnaire returned by 
2157 Québec nurses, was that 
the level of professional 
satisfaction is quite high. If 
they had to do it over again, 
three out of five of the 
responding nurses said they 
would choose the same 
profession. More than 
two-thirds of the nurses said 
that they were satisfied with 
their jobs 70 per cent of the 
time, although the younger 
nursing graduates tended to be 
less satisfied. Less positive 
statements appeared when the 
nurses were asked about the 
perception of their role by the 
public and doctors. Fifty-two 
per cent of the respondents 
said that in practice, doctors 
didn't differentiate between 
RN's and auxiliary nurses. 
Further, as far as the average 
patient could see, nurses were 
nothing more than doctors' 
assistants, claimed 59 per cent 
of the nurses. 
President Jeannine 
Tellier-Cormier made special 
note of the report's conclusion 
that nurses tended to be 
poorly informed and had 
difficulty getting away from 
their work to attend 
professional meetings; she 
said that the Order intends to 
undertake an in-depth study 
based on this important 
report . 
The next annual meeting 
of the OIIQ will be held in 
Montréal, November 5 to 7, 


CNA members and association 
members are invited to submit 
resolutions for presentation at 
the Annual Meeting and 
Convention, June 1980. 

Resolutions must be signed by a 
CNA member and forwarded to 
the Resolutions Committee, CNA 
House by 31 March 1980. 

Resolutions received after 31 
March 1980 cannot be presented 
to the annual meeting. 

CNA directors ready for 1980 
Health Minister fields questions 

A visit from Canada s Minister of Health to explain plans for the 
proposed National Health Care Institute and to answer questions from 
CNA directors about the current review of public health insurance plans 
in Canada was one of the highlights of the last regularly scheduled 1979 
meeting of the Board of Directors of the Canadian Nurses Association. 
Directors, too, were looking ahead, trying to determine the 
direction that growth and development within the nursing profession 
should take in the eighties. Based on their decisions at the October 
meeting at CNA House in Ottawa, nurses can anticipate action on their 
behalf this year on at least four fronts - all related, either directly or 
indirectly, to nursing education and to nursing practice. 

Getting going 
The first of these, "Operation Bootstrap", is a short term funding 
proposal aimed at developing a nation-wide systematic plan for 
improving the basis of nursing practice in Canada. The project, which 
carries a price tag of just over $5 million, calls for CNA to establish a 
seven-member Operation Bootstrap Committee consisting of 
representatives of CNA, the Canadian Nurses Foundation (CNF) and 
the Canadian Association of University Schools of Nursing (CAUSN). 
The author of the preliminary report on Operation Bootstrap, Dr. 
Shirley M. Stinson, president-elect of CNA, explained to directors that 
the choice of name for the project was deliberate. "The nursing 
profession must itself take the initiative to 'get going' using whatever 
resources it can currently muster and within whatever constraints 
currently exist. " The committee wilt be responsible for carrying out the 
preparatory phases of all five steps of the project: 
e obtaining "starter grants" for establishing a PhD nursing program 
. assisting interested institutions in obtaining initial funding for at 
least two nursing research centers 
. obtaining funds to introduce a Communicating Nursing Research 
. creation of a reliable system for obtaining essential data on 
Canadian nurses with doctoral preparation, and 
. setting up an emergency doctoral fellowship program. 
The proposal is an outgrowth of the Kellogg National Seminar on 
Dbctoral Preparation for Canadian nurses which took place in Ottawa in 
November. 1978. 
Funding for Operation Bootstrap wilt be sought from the WK. 
Kellogg Foundation, "the single most important outside source of funds 
in the history of Canadian nursing". 

Another long term project, accreditation of nursing education programs, 
will also be submitted to the Kellogg Foundation for possible funding as 
a result of a decision of CNA directors. A request from the association's 
ad hoc committee on accreditation that directors re-affirm the priority of 
this project was, however, turned down by the board. 




Health and Welfare '\1inister Da\id Crombiejoined directors of 
the Canadian Nurses A ssocia tion for a question and answer 
session during their recent three-day board meeting. Pictured 
above are (left to right): Dr. Shirley M. Stinson, CNA 
president-elect; Mr. Crombie: Helen Taylor, president ofCNA; 
Dr. Helen Mussallem, executi,'e director ofCNA and Sheila 
O'Neill, the association'sjìrst ,'ice-president. 

Continuing education 
A third area which directors agreed should receive special attention in 
1980 is that of continuing education. Members gave their wholehearted 
support to a resolution arising out of the NatIOnal Continuing Education 
Conference in Winnipeg last Spring (see The Canadian Nurse June 
1979) and supported by various provincial associations, "that CNA study 
the issues inherent in continuing education for nurses and produce a 
position paper on continuing education for registered nurses in Canada 
during the 1980-82 biennium." Directors agreed that, although they were 
not in a position to make a commitment on behalf of the board which will 
be elected for the coming biennium, they could and should endorse the 
presentation of this resolution to the first meeting of the new board 
following the CNA annual meeting in Vancouver in June. 

Members of the board were brought up-to-date on work on development 
of a definition of nursing practice and standards for nursing practice, 
recognized by CNA directors and membership as a priority in 1979. The 
project director reported that a seven-member task group is now 
meeting on a monthly basis in preparation for release of the final report 
in June, 1980. 

Ministerial visit 
Recently appointed Minister of National Health and Welfare, the 
Honorable David Crombie, joined CNA directors for lunch on the second 
day of the meeting. The occasion marked the first official visit of a 
Minister of Health and Welfare to the headquarters of Canada's national 
organization of professional nursing associations. 
In response to questions from the CNA directors, the Minister 
described some of the concerns prompting the current review of the 
status of publicly financed health insurance programs in Canada and 
said that the responsibility of the federal government in developing 
alternate methods of health care services and delivery systems, the cost 
of services and project funding will be determined after the Hall 
Commission review has been completed. 
Mr. Crombie agreed with CNA directors who argued that the review 
to be carried out under the direction of Mr. Justice Emmett Hall should 
be called a report on "health care services '79", a term the directors 
preferred to "medicare". He emphasized that the Hall Commission is not 
a Royal Commission and that its terms of reference have an overriding 
objective - to achieve more efficient health care delivery at less cost 
while still maintaining quality. Directors informed the minister that CNA 
would be submitting a brief to be considered in the review process and 
that work has already begun on this project. 
Mr. Crombie also discussed his proposal to establish a National 
Health Care Institute of Canada, an independent, non-profit corporation 
whose purpose would be to serve as a clearinghouse for Information on 
the Canadian health system, monitor national health needs and report 
their assessment of the effectiveness of the system in meeting these 
needs. He described the institute as "an objective third-party that will 
guard the interests of users and providers of services." 
Mr. Crombie and the directors discussed the expanding role of the 
nurse as well as federal and provincial responsibilities related to health 
care services. The minister said that he has been and will continue to 
meet with national health care organizations to establish productive 
working relationships. 

Other business 
Directors approved a resolution requesting the Canadian Institute of 
Child Health to convene a task force whose members would investigate 
the redefinition of roles of the nurse and physician in the light of changes 
that are occurring in maternity care in Canada today. Members of the 
task force would also be asked to look at the changing role of the 
Members of the board welcomed two new directors to their Fall 
meeting: Stephany Grasset and Jeanette Pick, presidents of the British 
Columbia and Alberta associations respectively. NBARN executive 
director, Bonnie Hoyt, was also attending her first CNA board meeting as 
provincial adviser. 

Jenuery 1980 7 

The Cenedlen Nur.. 

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Postal Code 

8 Jenuery 1980 

CNA executive director addresses 
"nurses in the marketplace" 

"Creative caring" was the 
theme of the 8th annual 
Ontario Occupational Health 
Nurses' Conference held in 
Toronto last October and 
attended by close to 400 
nurses. Dr. Helen Mussallem, 
executive director of the 
Canadian Nurses Association. 
gave the keynote address. Her 
speech prompted a standing 
ovation and comments 
afterwards on the "exciting" 
quality of her address. 
Dr. Mussallem said she 
believes that occupational 
health nurses have perhaps 
"the greatest and most unique 
opportunity to demonstrate 
and be involved in creative 
caring." The promotion of 
"healthful lifestyles" is 
important, she said, rather 
than concentration solely on 
the curing of illness. Dr. 
Mussallem regretted that the 
true "potential of nurses has 
never been realized...nurses 
are trapped in bureaucratic 
systems in the hospital and in 
the community." She closed 
by saying that in life the tragic 
people are those who "elect to 
be spectators" while 
occupational health nurses are 
in the dramatic position of 
practicing creative caring "in 
the marketplace" . 
Occupational health 
nurses are often the first 
contact an employee has with 
a health professional; these 
nurses therefore feel the need 
to be aware of all the 
possibilities in illness or 
dysfunction and all the 
resources available to them. 
The choice of speakers for the 
conference reflected this 
concern: presentations 
included an overview of 
communication techniques for 
use in relationship therapy, 
the importance of 
pre-retirement counseling and 
a discussion by Dr. John 
Jameson of Toronto on 
common phobias and their 

One of the problems 
commonly experienced by 
OHN's is a result of their 
position vis à vis management 
and fellow employees; 
difficulties are encountered in 
getting health programs "off 
the ground", and employees 
frequently see the nurse as 
part of management with 
whom they do not feel free to 
discuss personal problems. 
Evidence of this problem 
surfaced when Justice Horace 
Krever spoke about the 
confidentiality of medical 
records and nurses in the 
audience told him they are 
often under pressure to reveal 
confidential information to 
employers. Justice Krever 
asked the nurses to send him 
more information. 
A presentation entitled 
'Management's View of the 
Nurse' was given by Dr. G.H. 
Collings, medical director of 
New York Telephone. Dr. 
Collings stated that the image 
of an industrial health service 
ranged from that of a regular 
department with its own 
important function to that of a 
mere overhead expense 
required by law. The nurse's 
role varies correspondingly. 
he said, from a skilled worker 
with no influence to an 
integral member of the 
management team. To be fair, 
Dr. Collings said, "only rarely 
can a business afford the 
generosity of affording 
services that are not directly 
aimed at running the 
business." He emphasized 
that the nurse must 
understand this and work not 
only at providing good health 
care to the employees but also 
offering the company realistic 
help that it cannot refuse on 
economic grounds. In short, 
he said, how management 
views the company nurse is in 
fact, up to the nurse 0 

Columnist Corinne Sklar, author of You and the law, 
will return next month with another of her regular 
columns on legal issues affecting the nursing 

The Cenedlen Nur.. 




Seruing the Health Professions in Canada Since 1897 
75 Horner Ave., Toronto, Ontario M8Z 4X7 

By Lillian Sholtis Brunner, R.N., B.S., M.S.N.; and 
Doris Smith Suddarth, R.N., B.S.N.E., M.S.N. 
With nine contributors. 
This monumental Second Edition of a modern classic- 
the most comprehensive single-volume reference on 
nursing practice ever published-incorporates massive 
revision and updating to offer the latest and most 
accurate information available. Every chapter in every 
area has been updated and expanded. Numerous new 
procedure-guidelines (more than 60!) along with nursing 
care and management sections and treatment modalities 
have been added. Over 100 superb new illustrations 
beautifully complement the text. What this means is 
more detailed, substantive, and complete coverage of 
every phase of medical/surgical, maternity, and pediatric 

'fÞ t . ott 


2 edi tion 


lippincott. 1,868 Pages. Illustrated. 1978. $32.25. 

_filii Of\S 
g e '0 1 . 




Collection of Tips, Hints, Improvisations and Bright 
Ideas That Make Nursing Easier and Patients Happier 

By Arlene Odom Nichols, R.N., B.S.N., M.S.N.; 
and Joy Day, R.N., B.S.N. 

Here is a thoroughly delightful book, written and edited by a group of 
concerned, dedicated nurses who have gone quietly about the business 
of caring for sick people and noting little tricks (actually innovative 
solutions) that seemed to make things work better. Their discoveries 
or "pearls" are shared with you in an organized fashion, with the 
rationale for each nursing action clearly explained. Numerous illustra- 
tions accompany the text. 

lippincott. 250 Pages. 
Illustrated. Sept. 1979. $10.50. 



75 Horner Ave., Toronto, Ontario M8Z 4X7 
Please send the following for 15 days 'on approval': 
1 2 3 4 5 6 
o Lippincott Nursing Catalogue 
o Payment enclosed (postage and handling paid) 
o Bill me (plus postage & handling) 

Edited by Stewort M. Brooks, M.S. 
Little, Brown. 625 Pages. 
1978. $14.50. 

By Doris Carnevali, B.S., MoN.; and Maxine 
Lambrecht Patrick, B.S.N., M.S.N., D.P.H. 
Lippincott. 570 Pages. 
Sept. 1979. $22.50. 




By Charlotte K. Eliopoulos, R.N., M.S. 
Harper & Row. 384 Pages. 
Illustrated. 1979. $15.00. 

Postal Code 


Prices subject to change without notice. 


EXAMINATION, 2nd Edition 
By Barbara Bates, M.D. 
Lippincott. 440 Pages. 
Illustrated. 1979. $27000. 

Books are shipped On Approval; if you are not entirely satisfied you may 
return them within 15 days for full credit. 
Current nursing catalogue available free upon request. 

The Cenedlen NUrH 

Jenuery 1980 9 

Enterostomal Torture and the nurse Nurses in the news 
therapists The Canadian Medical Group, 
hold Canadian meeting part of Amnesty International, Helen Glass, director of the The New Brunswick 
has sponsored a seminar for School of Nursing, University Association of Registered 
The 12th annual conference of health professionals dealing of Manitoba was awarded the Nurses has announced the 
the International Association with the victims of political YWCA Woman of the Year names of 11 scholarship 
of Enterostomal Therapists torture. The meeting took award for Education. She is recipients for the 1979-80 
OAET) will take place next place in Toronto last October. nationally and internationally yearo These scholarships are 
year in Washington, DC, from A number of nurses attended recognized for her work as a awarded on the condition that 
May 22 to 25. the seminar and in groups nursing educator and has the recipient work in New 
Last year's conference, discussed the role of the nurse made a significant impact on Brunswick for a specified 
in May 1979, was a huge in the rehabilitation and the nursing profession as a period of time after 
success, drawing 500 treatment of torture victims. whole. Glass is a strong graduation. 
registrants from Canada, the Sponsors pointed out that protagonist on behalf of Karon Croll was awarded 
US, Mexico, Sweden, nurses and doctors in Canada women's rights and forthe $1250 for studies toward a 
Australia, Germany and South deal with torture on two professional status of nursing. Doctorate in Adult Education 
Africa. The event, which was levels: in treating the victims at Florida State University 
held in Vancouver, was as they arrive in Canada from Jeanette Pick, president of the and Lynne McGuire, who is 
hosted by the British othercountries,andin Alberta Association of enrolled in the Master's in 
Columbia ET group. More collaborating with Registered Nurses, was one of Education of Nursing 
than half of the total Canadian professionals from nations six "Women of the Year" Program at the University of 
membership of close to 100 where torture is prevalent. honored last Fall by the New Brunswick, received a 
Ef's were in attendance. Topics of discussion Calgary branch of the YMCA. $750 scholarship. 
Nurses interested in ranged from the physical and Pick, who is assistant director The Muriel Archibald 
obtaining more information psychological results of at the Foothills Hospital Scholarship, valued at $1200 
about the Canadian branch of torture, and proposed School of Nursing, was will be shared equally by 
the ET's should contact Linda government response to winner in the health category Frankie Fung, RN, Saint John 
Thomas, public relations refugee applications where of the awards which were and Nicole Roy 
chainnan, 3768 Bathurst torture has been medically given to mark "50 years of RN, Shédiac, who are 
Street, Apt. 214, Toronto, assessed. personhood" . working towards their 
Ontario, M3H 3M70 Baccalaureate of Nursing 
Did you know... Marie-Therese Laliberte, a Degrees at the University of 
Any Question About Pediatric Vancouver's St. Paul's Hospital Master's level student at the New Brunswick and the 
Nursing? The Department of has now certified 38 enterostomal Faculty of Nursing, Université de Moncton, 
Nursing of the Hospital for Sick therapists, all graduates of their University of Montreal, was respectively. 
Enterostomal Therapy 
Children, Toronto, would like to Educational Program for Nurses. recently awarded a NBARN scholarships 
help. Nurses are invited to call for The only Canadian I.A.E.T. Warner-Lambert Canada valued between $300 and $775 
information or consultation. Call 
the Medical Information Center approved program currently Limited nursing fellowship have been awarded to the 
(416) 597-1500, Extension 2620 available, St. Paul's is now award by the Parke-Davis following who are studying 
and you will be referred to the accepting applications for the Division. This $750 grant is towards a Baccalaureate of 
appropriate resource nurse. seven week program beginning made to selected candidates Nursing Degree: Jane Bartlett, 
November 3,1980. for the degree of Master of Woodstock; Elaine Bell, 
Science in Nursing at Woodstock; Pierrette Brun, 
Canadian universitieso Cap-Pelé; Sylvie Parisé, 
Notice of meeting Caraquet; Sandra Stever, 
Eleanor Nolan and Elizabeth Bathurst; Francine Thibault, 
CANADIAN NURSES Cochrane, who have been Ste. Anne de Madawaska; 
FOUNDA TION awarded the I 979 Judy Hill Mariette LeBlanc, Moncton. 
Memorial Scholarship, will 
In accordance with Bylaw, Section 36, notice is given of an each receive $3500 to continue Did you know... 
annual general meeting to be held on Sunday, 22 June 1980, their nursing education for A 42-year-old grandmother from 
eventual service in the Windsor, Ontario, was among 32 
commencing at 14:00 at the Hyatt Regency Hotel, Plaza Canadian Arctic. Eleanor Canadians who received bursaries 
Ballroom, (East/Center), Vancouver, British Columbia. Nolan, who began her nursing from the St. John Ambulance last 
year, enabling them to pursue or 
The purpose of the meeting is to receive and consider the service in St. John's, Nfld., advance their nursing careers. 
has worked in Labrador, Marilyn Roberts, mother of five 
income and expenditure account, balance sheet and annual Frobisher Bay, Australia and and grandmother offour children, 
reports. Irelando She is enrolled in the was awarded the Margaret 
Outpost Nursing and MacLaren Memorial Bursary in 
The election of the CNF Board of Directors for the 1980-82 term Midwifery program at August and is nOw attending St. 
of office will be conducted during the meeting. Memorial University, Nfld. Clair College in Windsor. Nine 
Elizabeth Cochrane, a other winners are taking post 
basic training and one is studying 
All members of the Canadian Nurses Foundation are eligible graduate of Conestoga for her Master's. Deadline for 
to attend and participate in the annual general meeting. College, Kitchener, Ontario, applications for this year's 
is presently studying bursaries is May I. 1980. Write: 
Helen K. Mussallem midwifery at the Aberdeen St. John Ambulance, National 
Maternity Hospital, Scotland. Headquarters, P.O. Box 388, 
Secretary- Treasurer Terminal 'A', Ottawa, Ontario, 
Canadian Nurses Foundation KIN 8V4.41 

10 Jenuary 1980 

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Post convention 

Plan your holidays around the 
convention! Post convention tours and 
travel packages* now being arranged 

San Francisco 

14 days - $600-900 
4 days - $290 
8 days - $440 
7 nights - $300 

Reno - Tahoe 

1-3 days - from $40 

'The Island Princess cruise" 
June 27 -July 5 
U.S. $1500-1600 
Victoria 1-3 days - from $40 
The Royal Hudson Steam Train 
Excursion 10 hours - $30 

Details will be in the February issue of 
The Canadian Nurse and advance 
reservations will be essential. 

In the meantime, the RNABC Hosting 
Committe'e needs your help in estimating 

Cut and return to: 

RNABC Hosting Committee 
2130 West 12 Avenue 
Vancouver, B.C, 
V6K 2N3 

Yes, I am planning to extend my stay. 
I want to tour (list choices) 




The time I have is 



I CNA moves West for 1980 meetin 
I 'Today's issues - tomorrow's nursin 
I . 

Something for everyone. That's the 
claim of this year's program 
organizers who have been hard at 
work on planning an action-packed 
agenda for CNA's annual meeting 
and convention in Vancouver. 
Highlights will include: 

. A speciall\.ellogg Lecture on the 
nurse's role in delivering primary health 
care by Dr. LeaZwanger, head of the 
ion of Allied health profession
Ministry of Health, Tel Aviv, brael. 

. "Who shapes nursing in the 
eighties?", the keynote address for the 
convention. will be delivered by Lorine 
Bese!, director of nursing at the Royal 
Victoria Hospital in Montreal. 

. A special session on the health care 
dollar featuring a noted commentator 
from the Canadian economic 

. A panel presentation on the labor 
mowment vis à vis the professional 
association featuring discussion belween 
a labor analyst and two members of the 
nllf'iing profession. 

A debate on the always 
controversial question of mandatory 
versus voluntary contmuing education. 

· A social program that will include a 
wine and cheese reception as well as a 
dinner featuring entertainment with a 
B.c. flavor. 

This year's theme - "Today's 
issues - tomorrow's nursing" - 
leaves no doubt about the relevance 
of the 1980 program. So, plan on 
keeping up, keeping informed. 
Make sure you're there. 


...... I 






.... . 

:- ..'.,.r-...., 





. - . 
,t .., 
r a 





'- .
. ..- 





J I I forCNA's 
II - Annual meeting and convention 
- I Hyatt Regency Hotel 
- Vancouver, B.c. 
. I 
. June 22-25, 1980. 
1= . 
 . I 
. . 
I - 
': - 
.... ,- I 
'. , 
:--.. .. .IIIIQ I - 
. - I Registration Fee 
'l - 
-. - (includes Monday luncheon and Tuesday 
'...= I dinner) 
... . . 
. . " " 
, . . Ao I 
Three days Daily rate 
, .... 
... II , t ." I . CNA member $1001 40 
.. -, I- ..' JII' I, 
," I . Non-member $1501 60 
l .I\.l1o- . Nursing student $401 20 
it - I 
I I wish to attend (days circled) 
. I Monday 
. I 
.... Tuesday 
. . ;, - 
- -- 
" Wednesday 
. I 
'. I Please mail my receipt, admission card 
- '.- with convention kit, ticket and 
.11 .. - .. . I procedure for registration to: 
I Name 
. ,., I (Surname first) 
-- . 
, I 
I Address 
I Present employer 
\ . I Prov/Terr of Reg'n 
I \ 

 \ I 
. , I Reg'n No. 
jt- " 
.. l I ':1 r
.. "- . 
I enclose cheque or money order payable 
LUW .. I to Canadian Nurses Association, 50The 
I Driveway, Ottawa, Ontario, K2P IE2. 
I . I wish to receive a reservation card 
I for accommodation at the Hyatt Regency. 
I (See December CNJ for details of other 
I accommodation) 

names & faces 

Stephany Grasset of 
Vancouver has been elected 
president of the RNABC for a 
two year term. A nursing 
instructor at the British 
Columbia Institute of 
Technology, she has a long 
record of participation in 
association affairs and is 
experienced in both hospital 
and public health nursing. 

Heather Caloren, BScN, 
MScN, has been appointed 
Assistant Director - N urs ing 
Service for the Elderly with 
the Victorian Order of Nurses 
for Canada. A graduate of the 
University of Toronto School 
of Nursing, she will be 
providing advisory and 
consultative services related 
to program development at 
the branch level, developing 
and establishing educational 
programs for VON staff and 
maintaining liaison with 
government departments and 
other voluntary agencies. 


The Edith Dick Fund has been 
established in memory of the 
life and work of the late Edith 
RainsfordDick, an inspector 
and director with the Ontario 
Department of Health from 
1932 until 19640 Widely 
respected for her contribution 
to health services and nursing 
in Ontario and Canada, her 
efforts in the Second World 
War were recognized by King 
George VI in 1944 with the 
Royal Red Cross, first class. 
The fund will be administered 
by the RNAO Foundation to 
develop and promote nursing 
practice in response to 
changing health needs. 

Carol Hoganson, RN, a former 
employee of the Halifax 
Infirmary operating room, has 
won the Deknatel Educational 
Award for Canada for her 
invention of an intravenous 
clamp which more accurately 
controls the flow of 
intravenous solutionso 

. w. a:

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t ..'
.'" :- 
.. -ç. 
.,.:'.:. ..... 

.:: .y' 
.. "... 

Western Australian Institute of Technology 

Department of Nursing 

Teach and arrange clinical placements for nursing 
students in the diploma and Bachelor of Applied 
Science courses (Community Nursing Practice). 
Applicants must be registered general nurses with 
recent experience of health care delivery in com- 
munity settings. Preference given to applicants with 
degree or additional appropriate qualification. 

Selery Range: lecturer' SC21.067 - $27.677. Senior Tutor: 
SC lB. 15B - SC20. BOI. (October 26 E_change Rate) 

Tenure: The abOlie position is available with permanent tenure. 
However the Institute IS Interested in receiving applications from 
persons prefernng a limited term appointment. 
Condition.lncluda: Four weeks annual leave. fares for appointee and 
family plus some assistance for removal e_penses. Superannuation 
is available for staff with permanent Tenure. Return fares are provided 
for staff appointed for a Limited Term. 
Applice1ione: Detailed application including the names and addresses 
of three referees should be submitted not later than 31st January to 
the Appointments Officer. Western Australian Institute of Technology. 
Hayman Road. South Bentley 6102. Western Australia. 
When applying please quote position reference number and media 
code CN3 


14 Jenuery 11180 

Donna Meagher (B. Sc. N ., 
Mount S1. Vincent 
University) and Sheila Ross 
(BoN., McGill University) 
both of Halifax, are 
co-winners of the Frances 
MacDonald Moss Scholarship 
awarded annually by the 
Registered Nurses 
Association of Nova Scotia. 
The scholarship of not less 
than $3000 is awarded to 
members of the Association 
wishing to undertake further 
education in nursing. The 
winners will each receive 
Meagher, currently on 
the Faculty of the School of 
Nursing at Dalhousie 
University will begin studies 
for a Master's degree in 
Health Sciences at McMaster 
University, Hamilton, 
Ontarioo Ross, who is 
assistant director of nursing at 
the Victoria General Hospital, 
Halifax will begin studies for 
an M.N. at the Dalhousie 
School of Nursing. 


Sister Anne Deas, s.s.a., 
formerly Director of Nursing, 
S1. Joseph's Hospital, 
Victoria and S1. Boniface 
General Hospital, Winnipeg, 
has been appointed Director 
of Nursing, S1. Paul's 
Hospital (Grey Nuns') of 
Saskatoon, Saskatchewan. 
She is a graduate of Gonzaga 
University, Spokane, 
Washington (BScN), and the 
Catholic University of 
America in Washington DoC. 
(Master of Nursing Service 

Jean Rose has been appointed 
to the position of Nursing 
Consultant-Education with 
the Association of Registered 
Nurses of Newfoundland. A 
graduate of Sydney City 
Hospital School of Nursing, 
Sydney, N.S., Dalhousie 
University (BoN.) and Boston 
University School of Nursing, 
Boston, Mass. (MoSc.N .), she 
has had a variety of clinical 
experience and has chaired 
the Nursing Education 
Committee of the RNANS 
and the Nursing Education 
Committee of the College of 
Cape Breton, NoS. 

The CanAdian Nur'.. 

Mary E. Murphy has recently 
been appointed 
Vice-President, Nursing at the 
Vancouver General Hospital. 
A graduate of S1. Joseph's 
School of Nursing, London, 
Ontario; University of 
Windsor (BScN) and the 
University of Ottawa (MHA), 
she has held many 
supervisory and 
administrative positions. Most 
recently, she has been 
Vice-President, Nursing with 
the University of Alberta 
Hospital in Edmonton, 
Always active in her 
professional associations, 
Murphy is currently Chairman 
of the Ad Hoc Committee on 
Graduate Education of the 
Alberta Association of 
Registered Nurses. 

Thelma Jane May (R. N ., 
School of Nursing, Hospital 
for Sick Children: B.Sc.N., 
University of Toronto) has 
been appointed director, 
Nursing Service at the 
Bloorview Children's 
Hospital, Toronto. She first 
went to Bloorview in 1975 and 
since then has served as 
administrative supervisor and 
assistant director of Nursing 
Service. Previously, May held 
administrative positions at the 
Hospital for Sick Chi:dren and 
at Women's College Hospital 
in Toronto. 
May is also actively 
involved in the S1. John 
Ambulance Brigade and is 
currently chairman of the 
Nursing Advisory Committee 
of that association. 

Rosette Leduc-Grand'Maison 
has received the United 
Nurses Award of Merit for 
having rescued a child from 
drowning in 1978. The United 
Nurses Inco, P.Q., annually 
honors a nurse whose 
achievement during the past 
year has warranted public 
recognition and has enhanced 
the profession of nursing. 
Certificates of merit have also 
been awarded to Diane Roy of 
Ste-Justine Hospital and 
Yvette Pratte-Marchessault of 
Notre Dame Hospital, 

Margaret Scott Wright, the 
present director of the School 
of Nursing at Dalhousie 
University, Halifax has been 
appointed dean of nursing at 
the University of Calgary. 
Scott Wright obtained her 
doctor of philosophy degree in 
the faculty of medicine at the 
University of Edinburgh 
where she later became 
director of the department of 
nursing studies in the faculty 
of social science. In addition 
to serving on many 
government and professional 
committees in the U.K. and 
Europe, she was 
vice-president of the 
International Council of 
Nurses and acted as an 
advisor and consultant to the 
World Health Organization on 
many occasIOns. 
Scott Wright begins her 
five year appointment as dean 
of nursing at U ofC on Sept. 
I, 1979 succeeding Marguerite 
Schumacher who will remain 
in the faculty. 

Jo}ce Perrin, BScN, DHA. 
has recently been appointed to 
the position of administrator 
of the Bloorview Children's 
Hospital, Willowdale, 
Ontario. A graduate of the 
University of Alberta School 
of Nursing and the University 
of Toronto School of Hospital 
Administration. she has held 
many nursing and 
administrative positions, most 
recently Assistant Executive 
Director of the Canadian 
Council on Hospital 

Three Alberta nurses received 
scholarships from the 
professional association in 
that province this year. 
AARN scholarship winners 
are: Walter Bredlo
 and Linda 
Reutter. Bredlow, a clinical 
nurse specialist in Medicine 
Hat, is now enrolled in the 
second year of a doctoral 
program in marital and famil} 
therapy in California: Linda 
Reutter, a community health 
nurse in Edmonton, has 
entered the University of 
Colorado this Fall to complete 
a Master of Science degree in 

Community Health Nursing. 
A third scholarship was 
received by Elizabeth 
l\lillham, instrucror! 
coordinator at the Holy Cross 
School of Nursing in Calgary, 
now enrolled in the final year 
of a Masters in Educational 
Administration Program at the 
University of Calgary. 

Irene Ross McPhail. R. N., was 
recently elected president of 
the St. John Ambulance 
Federal District Council. the 
first time that this position has 
been held by a woman. 
McPhail, a graduate of the 
University of Alberta Hospital 
and the Medical Centre of 
Cornell University, joined the 
Federal District Council in 
1964 as provincial nursing 
officer and two years later 
became the provincial 
superintendent of nursing. In 
1972 she was appointed 
provincial commissioner- 
another first for a woman. 
Apart from her 
outstanding service to the 
Federal District Council. 
McPhail has also contributed 
substantially at the national 
level. Through her active 
interest in the field of health 
care, she has provided 
valuable consultation in the 
development of the expanded 
St. John Ambulance home 
nursmg program. 
In recognition of her 
contributions to St. John 
Ambulance, McPhail holds the 
grade of Dame of Grace, one of 
the highest honors awarded by 
the Order of St. John. 

Carol Roberts. a graduate of 
the Royal Victoria Hospital 
School of Nursing, Memorial 
University (B.N.) and Boston 
University, Mass. (\J.Sc.N.) 
has been appointed Nursing 
Consultant-Practice with the 
Association of Registered 
Nurses of Newfoundland. She 
has worked in various 
capacities in medical, surgical 
and pediatric nursing and 
most recently taught 
medical-surgical nursing at the 
University of Ottawa School 
of Nursing. 

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Back to basics, nursing educators face up 
to needs of the eighties 



- _-..--..I 







1'5'" IORIS 






Reaction panel members at CNA' s nationalforum on nursing education were (left 
to right ): Jocelyn H ezekiah, C écile Lambert, keynote speaker Alice Baumgart, 
chairman Margaret McCrady, Dorothy Kergin and Ann Hilton. 

Canada's top nursing educators, faced 
with the warning that they do not have 
unlimited time to debate the issues 
involved in preparing tomorrow's 
practitioners, came up against a wall of 
words at their first national seminar in 
Ottawa in mid-November. 
The warning that the clock was 
running out Came on the first day of the 
three-day conference and was delivered 
by keynote speaker, Alice M. Baumgart, 
dean and professor at Queen's 
University School of Nursing in 
Kingston, Ontario. Baumgart reminded 
her 350 felIow nurses attending the 
meeting of "the growing urgency of 
setting out clearly the differences in the 
roles and competencies of the various 
types of nursing practitioners." 
"Time is running out for nursing to 
put its educational house in order," she 
warned. "Out of enlightened 
self-interest, nursing educators should 
get on with this task. Otherwise, 
necessary choices wilI be made 
increasingly by others, often to the 
detriment of nursing and pa
ient care 0 " 
Baumgart calIed on nurses to begin 
work on the development of a 
"comprehensive and long term systems 
approach" to planning basic nursing 
education and predicted that critical 
questions related to basic nursing 
education in the eighties will center 
around the overalI responsibilities of the 
system, specificalIy. the problems of 
managing with increasingly limited 
resources and the need to develop 

political processes that encourage 
responsiveness and accommodation, 
rather than confrontation and restricted 
The National Forum on Nursing 
Education. the first of its kind in Canada. 
was sponsored by the Canadian Nurses 
Association and grew out of a resolution 
approved by delegates to CNA's annual 
meeting in Toronto lastJune. More than 
200 of the 343 participants were 
educators who represented a total of 41 
community colIeges, 22 university 
schools of nursing and 21 hospital 
schools of nursing from right across the 
country . 
The conference theme, "The nature 
of nursing education" , gave rise to 
speeches and debate on the folIowing 
. basic nursing education 
. implementing the curriculum based 
on a nursing model 
. basic nursing service 
. nursing skilIs/competencies 
. perceptions of the new practitioner 
. specialization in nursing 
. national accreditation of nursing 
education programs. 
In the end, folIowing three days of 
discussion, delegates approved the 
principle of holding other similar 
conferences on nursing education, with 
the proviso that in the future one or two 
issues be chosen for examination at each 
conference. They suggested that the 
focus for the next conference should be 
an examination of the clinical component 
in basic nursing programs. 

Speakers taking part in the panel 
discussion that folIowed the keynote 
address focused on some of the key 
issues facing nurse educators today. 
"Nurses must realize they cannot be alI 
things to alI people," Dorothy Kergin, 
director of the University of Victoria 
School ofN ursing, warned her audience. 
The fonner associate dean of Health 
Sciences (Nursing) at McMaster 
University spoke of the growing need for 
colIaboration and close working 
relationships between nurse 
practitioners and educators. Two of the 
critical questions that nurses must ask 
themselves, she said, are who is going to 
set standards for nursing education and 
what are the health needs that nursing 
must address. 
The three other members of the 
panel included the president of the 
Registered Nurses Association of 
Ontario, Jocelyn Hezekiah. who is 
chairman of basic nursing programs in 
the Health Sciences Division of Humber 
ColIege of Applied Arts and Technology 
in Toronto; Cécile Lambert, professor at 
Maisonneuve ColIege in Montreal and 
provincial coordinator for diploma 
nursing programs in Québec; and Ann 
Hilton, assistant professor, Faculty of 
Nursing at the University of British 

What is nursing? 
"What is a nurse, what does a nurse 
do?" The answer, according to Evelyn 
Adam, associate professor of nursing at 
the University of Montreal, lies in our 
mental picture of nursing, how we 
conceptualize our profession. Nurses 
now want recognition of not only their 
dependent role, but also their 
independent or autonomous role - a 
role which is not entirely clear and 
therefore not easily communicated to 
others. The solution according to Adam, 
whose address was titled "Issues in 
implementing the curriculum based on a 
nursing model", lies in adoption of a 
conceptual model, ie. a way oflooking at 
nursing that is precise and explicit 
enough to give nurses direction for 
practice, education and research. 

Nursing skills and service 
Four nurses, Marie Cruise, Ginette 
Rodger, LucilIe Parent and Marie White, 
presented four different aspects of 
"Nursing service - what is it?" on the 
morning of the second day of the 
conference. Marie White, director of 
inservice education at Sir Thomas 
Roddick Hospital in StephenvilIe, 
Newfoundland, spoke on nur..ing service 

1 R aI.nll.rv 1 AM 

Thill Can.dl.n Nllr.. 

Evelyn Adam 
in a small hospital and commented that 
the character of service depends on a 
number of factors such as management 
philosophy. accreditation status and 
available manpower. She said that 
nurses told her they felt nursing service 
was becoming more task-oriented 
because of manpower constraints, and 
many felt unhappy that they were 
performing those tasks for which they 
would be held accountable by 
supervisory staff-in other words, they 
were "just doing the things that 
showed". In discussion afterward, Alice 
Baumgart commented that nurses were 
still perfonning the "housewife and 
mother" function in health care, keeping 
everything together and going. Ginette 
Rodger, director of nursing at Notre 
Dame Hospital in Montreal, said that "it 
is useless for us to get together like this 
(nursing service and educators) and just 
complain at each other," and she added 
that practice and education must go hand 
in hand to keep pace with the kind of 
service nurses wish to provide. 
The theme of skills versus theory 
continued when Margaret Steed, 
associate professor at the University of 
Alberta, gave a paper on .. Whatever 
happened to nursing skills?" She made 
note of the controversy about the new 
nursing graduates, that critics say 
today's new grads are not prepared to do 
'real nursing' . She acknowledged that 
"the basic nursing programs cannot and 
will not be able to provide all the skills 
essential to work in health care." The 
answer in part has been to develop the 
trend toward competency-based 
education which attempts to provide 
graduates with marketable skills based 
on the needs specific to a particular 
situation. Steed concluded by saying that 
educators cannot be smug about the 
needs of the new nursing graduate, but 
neither can those involved in nursing 
practice fail to acknowledge the 
necessity of a theoretical knowledge 
base; education and service must work 
together to build professional nursing 

Following this presentation two 
recent nursing graduates, Margaret 
Edmonds, staff nurse at Victoria General 
Hospital in B.c.. and Heather Smith, 
who is studying for her post-RN BScN 
degree, spoke on their experiences as 
new practitioners: both stated that they 
wondered if the transition from student 
to graduate wouldn't ha ve been easie r if 
they had had more clinical experience 
during their education period. Patricia 
Stanojevic, special projects officer at 
George Brown College in Toronto, in her 
paper "Reducing Reality Shock" 
allowed that this phenomena was not 
unique to nursing. that the graduates of 
many professions experienced the same 


Heather Smith 

sort of feeling once thrust into the role of 
practitioner. An RNAO project 
investigating reality shock identified the 
need to sensitize the nursing student to 
the real world through planned learning 
activities and the need for nursing 
education programs and health care 
agencies to work together to ease the 
transition for new practitioners. This 
might be accomplished through 
individualized hospital orientation 
programs, s he said. 





The nurse specialist 
Specialization in nursing was the theme 
of Madeleine Blais' presentation on the 
final morning of the conference. She 
defined the nurse specialist as "one who 
has acquired specific knowledge either 
by formal education or by the kind of 
experience which fosters the 
development of specific knowledge and 
skills." Blais is the nurse responsible for 
nursing education research for the Order 
of Nurses of Quebec, and is also 
vice-president of the Commission for 
Adult Education of the Quebec Council 
of Advanced Education. 

A chequered histof} 
The notion of a system for the 
accreditation of educational programs in 
nursing goes back to the thirties when 
nursing associations in this country first 
suggested that there should be a body 
charged with responsibility for 
Dominion-wide registration for nurses. 
The Canadian Nurses Association, 
according toCNA's second 
vice-president Myrtle Crawford, who is 
also professor and assistant dean of the 
College of Nursing of the University of 
Saskatchewan, approved the principle of 
accreditation in 1945 and, at that time, 
set up the first of numerous committees 
charged with examining the question. 
Crawford described the procedure since 
then as one of "alternately approving the 
principle. appointing a committee or 
study group to consider the question and 
then, finally, backing away from the 
decision. " 
Along the way there have been 
several noteable landmarks, including an 
evaluation of Canadian schools of 
nursing carried out by the current 
executive director ofCNA, Helen 
Mussallem, which resulted in publication 
of the report, "Spotlight on nursing 
education" . 
The most recent attempt involves an 
ad hoc committee set up by CNA 
directors in response to a resolution 
passed at the association's 1978 annual 
meeting. This committee, working with 
representatives of the Canadian 
Association of University Schools of 
Nursing who have had an accreditation 
project underway for several years, has 
now come up with a proposal that CNA 
directors approved at their last board 
meeting. Funding for the project, which 
will cost in the neighborhood of 
$800,000, is being sought from the WoK. 
Kellogg Foundåtion. 
Crawford warned, however, that the 
outlook for this proposal is "not over- 
whelmingly favorable" since the p.20. 

'* f. 

Margaret Edmonds 

ThA r.nAlilan NI.

1Ia.n 11" 

Mosby is the nursing publisher. 

A New Book' 
By Lucille F. Whaley. R.N.. M.S. 
and Donna L Wong. R.N.. M.N.. 
P.N.P.; with 5 contributors. 
This outstanding volume 
provides a comprehensive 
approach to the care of the well. 
III and handicapped children. 
By applying pnnclples of 
normal growth and develop- 
ment. It discusses the 
Implementation of physical 
assessment In planning care 
. . offers a conceptual 
understanding of pathologic 
processes. . . and describes 
those nursing Interventions 
essential to restoring health/ 
Consistent throughout. 
chapters reflect a dual concern 



for promoting the health of the 
well child and caring for the III 
or disabled child. Highlights 
· a distributive nursing 
care approach: 
· summaries of nursing 
care that offer guidelines for 
action follow major sections: 
· emphasis on and guide- 
lines for communicating with 
children and their families; 
· lab data and pharmacol- 
ogy are Incorporated 
Numerous quality tables 
and illustrations clarify 
common conditions and 
nursing care. This volume 
presents both an effective 
developmental framework. and 
a systems orientation. Why not 
evaluate It for yourself? 
March. 1979. 1.734 pages. 
746 illustrations. Price. 826.50. 




A New Book! FAMILY- 
Ten. By Celeste R. Phillips. 
R.N.. M.S. This modularized text 
offers a family-centered 
approach to basic maternity 
care. Well-Illustrated units 
cover all aspects - from 
pertinent anatomy/physiology. 
conception. the antepartum 
family. and preparation for 
childbirth to the Intrapartum 
family with complications. the 
newborn. and trends In 
childbearing. Each unit: states 
goals; Identifies behavioral 
objectives (keyed throughout 
the text!: and concludes with 
evaluation exercises. April. 
1980. Approx. 432 pages, 323 
illustrations. Aboul 814.50. 




The Nurse 
and the Family 
By Margaret Duncan Jensen. 
R.N.. M.S.: Ralph C. Benson. 
M.D.: and Irene M. Bobak. R.N.. 
M.S.: with 2 contributors. 
Both contemporary and 
humanistic In approach. this 
Important volume can help the 
student function more effec- 
tively as a maternity nurse In 
today's changing society. 
Following the chronologlc order 
of childbirth. It discusses the 
blopsychosoclal aspects of 
human sexuality. then proceeds 
to family planning. pregnancy, 
Interferences with nonnal 
pregnancy. labor and Its 
complications. the postpartum 
period. and both normal and 
high-risk Infants. Throughout. 
the authors: 
. Inlegrate diagnostic. 
therapeutic. and educational 
. present Inlerventlon plans: 
. and combine clinical and 
psychosocial aspects to provide 
a unique view oftotal patient 
and family care. 
Timely discussions explore 
such key topics as genetics. legal 
factors. fathering. and P.O.M.R. 
Over 600 illustrations highlight 
plans for nursing intervention. 
1977.784 pages. 684 
Illustrations. Price. 824.00. 

A Neu' Book! 
A Guide for 
Nursing Practice 
By Margaret Duncan Jensen. 
R.N.. M.S. and Irene M. Bobak. 
R.N.. M.S. 
A convenient. practical 
supplement to any maternity 
care text. this new book 
explains how to care more 
effectively for women and 
families during the child- 
bearing cycle. All aspects are 
discussed from maternal 
adaptations. assessing the 
maternal fetal/placental unit 

and care plans tor normal 
childbirth to high-risk 
condition. Infertility and family 
planning. Highlights Include: 
. guidelines for assessing 
the maternal/fetal/placental 
. presents prenatal. natal 
and postnatal care plans for 
normal childbirth: 
. delineates assessment 
and care of the normal 
· cross-references all 
material for ready reference. 
February. 1980. Approx. 304 
pages. 133 illustrations. About 

Child health 




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New 2nd Edition! CIllLD 
Concepts in Family-Centered 
Care. By Peggy L. Chinn. R.N., 
Ph.D. A conceptual approach 
. . . a problem soh1ng 
framework. . . a strong 
emphasis on the holistic 
person of the child. Students 
Will benefit from all of this In 
the new edition of this exciting 


text. It reflects contemporary 
ad\'ances In diagnosis and 
quality assurance as It 
examines such topics as 
problems of single parent 
families. care of the terminally 
ill child. high risk infants. 
nursing assessment and 
specific health problems. 
March. 1979.948 pages. 377 
illustrations. Price. 824.00. 


lei h alth 





All prices subject to change M4B 3E5 


: , 

New 2nd Edition! CIllLD 
Guide to CUnlca1 Assessment. 
By Peggy L. Chinn. R.N.. Ph.D. 
and CynthlaJ. Leitch. R.N.. 
Ph.D. This concise text selVes 
as both a student-ortented 
learning guide for comprehen- 
sive health assessment and as 
a source of Information for 
effective pediatric care. The 
authors present a wealth of 
Information on developmental 
differences obselVed from birth 
through adolescence - 
Indicating possible devIations 
and their health care 
implications. For added 
convenience, Information 
needed to Implement a care 
plan Is cross referenced. March. 
1979. 166 pages. 24 illustra- 
tions. Price. 89.75. 


When you want to refine, refresh, reassess. . . 
look to us! 

Back to basics (continued) 
association is already committed to two 
high profile, high priority projects- 
development of standards for nursing 
education and promotion of doctoral 
education for nursing in Canada. 
"Canadian nursing will be 
successful in obtaining funding for this 
project and in finally establishing an 
accreditation program for nursing 
education in Canada onl y if it is 
wholeheartedly supported by Canadian 
nurses. Ifthere is little enthusiasm for 
the goal of a national accreditation 
program this should be determined now 
and the question of accreditation put to 
rest for the next 30 years so that energies 
can be directed towards other high 
priority items of the profession. In my 
view it would be a serious mistake if this 
were to happen." 
Canada's first nursing education 
conference closed with 
recommendations from the floor 
touching on various aspects of the 



\ ,
!.' '. 

... ..
\." " 
,-', t., 
I , 
. 'i" 



discussion during the preceding three 
days. Among the concerns voiced by 
participants were: 
. the need to examine the clinical 
component in basic nursing education 
. the need for collaboration between 
inservice departments in places of 
employment for nurses and educational 
. the need for the national association 
to take a stand on whether basic 
preparation for entry into nursing should 
be at the baccalaureate level by a certain 
. the need for a "rotated internship" 
for new graduates that would be the 
responsibility of nursing education rather 
than the employing agency 
. the idea of a mandatory clinical 
practice component for nursing 
instructors to be completed annually 
. the need for increased 
communication between diploma and 
university nursing levels of education. 
along with consultation with the service 



# = 


component in the development of 
nursing education programs. 
Members of the committee 
responsible for planning the forum dre: 
chairman Margaret .\lcCrady. director of 
educational services, Nursing. Health 
Sciences Centre. Winnipeg: Jessica 
Ryan. head nurse. Pediatric Service. 
Chaleur General Hospital. Bathurst. 
N. B.: :\1arie- Thérèse Choquette, director 
of professional nursing for the Order of 
Nurses of Quebec; Pat Kirkby, 
coordinator of the Diploma Nursing 
program, Cambrian College, Sudbury, 
Ontario: Ruth Elliott. assistant 
professor. Faculty of Nursing, 
University of British Columbia. 
.. Back to basics" , a report on the 
conference proceedings. including the 
text of all the papers presented, 
discussion and commentary, is now 
being prepared. Information on this 
publication will be carried in a 
subsequent issue of The Canadian 





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The Canadian Nuree 





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of the 




Herpes simplex type I 
500,000 x 

Photograph of Herpes Simplex TJ'I>e I Virus (tJ'l>es I and 2 ha,'e similar appearance) 

HERPES, a viral infection which 
manifests in distinctive skin lesions, or 
fever blisters, has been around for a long 
time. AGreek word meaning 'to creep', 
herpes is responsible for the common 
'cold sore' . Now the herpes virus is 
causing COncern because the type which 
affects the genital area, herpes genita/is 
(or simply, genital herpes) has been 
affecting young men and women in 
North America at an alarming rate. 
Transmitted through sexual contact, 
genital herpes is a venereal disease and is 
thought by some researchers to be 
responsible for some 13 per cent of cases 
of venereal disease in the U.S.] 
However. genital herpes IS not a 
reportable disease, and so no statistics 
are likely to be accurate. 
There is good reason for the 
concern: because all types of herpes are 
a latent infection, (see Virus) once an 
individual contracts a herpes infection he 
has it for the rest of his life. In addition to 
this dangerofrecurrence, genital herpes 
can cause severe problems in newborn 
babies, and can endanger the life of the 
unborn fetus. Further, some medical 
researchers believe genital herpes is 
linked to cervical cancer in women. 

22 January 1980 

It is obvious then that nurses need to 
have some knowledge, not only of the 
genital type of herpes, but of the other 
types of this virus as well, especially 
since serious misconceptions exist about 
all forms of herpes. 
There are four types of herpes virus 
that dre most common. Varicella-zoster 
vÌl'us, often called shingles, appears as 
small reddened bumps on the skin of the 
trunk, arms and legs. Herpes is what is 
known as a neurotropic virus. meaning 
the virus lives in or remains latent in 
nerve tissue, and in some cases of herpes 
zoster this fact is most apparent. The 
bumps can be seen to follow networks of 
nerves, and on a patient's back may form 
a tree-like pattern. It is a common belief 
that if the "shingles meet, you'll die". 
This of course is not the case, and a 
nurse must ensure that her afflicted 
patient does not believe in this old wives' 
tale. Herpes zoster may appear later in 
life as a recurrence of chickenpox, which 
is caused by the same \'arice/la zoster 
virus. The recurrence can be a very 
painful experience and herpes can in 
fact be life-threatening in patients 
receiving immuno-suppressants such as 
transplant patients and in newborns. 

The Canadian Nur.e 

Cytomegalovirus is also a member 
of the herpes virus family. It rarely 
causes symptoms in adults but can cause 
a congenital infection in infants. 
A third is the Epstein Barr virus, 
which is related to Burkitts lymphoma, a 
malignant tumOr of the Iymphoreticular 
system, which is found mainly in 
children in Africa. 
The fourth type of herpes is herpes 
simplex, of which there are two groups, 
called simply I and 2. Herpes simplex I 
is responsible for most of the small sores 
appearing as blisters on the face, around 
the lips, often called "cold 
sores. "Contrary to popular opinion, 
genital herpes is not always caused only 
by herpes simplex 2 (HSV2) - usually, 
but not always. In genital herpes the 
virus is spread generally through sexual 
contact, 2 and the viruses pass through 
the skin and mucous membranes to the 
nerve tissue. Incubation period is 
thought to be two to 20 days, with six 
days being the mean; duration of the 
initial infection is up to three weeks, 
while recurrences last usually about to 

Figure one: Latent stage 

A person who is suffering an initial 
attack of genital herpes may complain of 
any or all of the following symptoms: 
general malaise, fever. 
lymphadenopathy (sore glands) and 
painful swelling of the genital 
area. 3 T ran'iient blister-like sore.. and 
then characteristic ulcers will appear on 
the labia in women, and on the penis and 
scrotum in men. Urethritis commonly 
occurs. and voiding. especially for 
women. may be extremely painful and 
difficult. If urinary retention exists, 
patienls may have to he hospitalized. 
. Satellite le
ions'. blister ..ores similar to 
the ones found on the genital area. may 
appear on other parts of the patient'.. 

It is an unfortunate fact that there is no 
real treatment for genital herpe'i - 
nothing works. 4The best course at the 
moment is to treat the patient's 
symptoms which includes giving 
adequate analgesia, ASA for fever, and 
to recommend rest. Sitz baths may be 
suggested, and patients may benefit from 
being told to try voiding while sitting 
either in the Sitz or a tub bath of warm 
water. Under nu circumstances should 
any steroid or anti-inflammatory 
preparations be used! 
Doctors are researching new 
methods of treatment, but so far none 
has proved totally effective. One method 
involved applying ether to the herpes 
lesions, but patients concluded that the 
treatment was worse than the disease. 
Others have been trying light treatments, 
various cream preparations,' even 
contraceptive foam fi but, as one doctor 
from the Centre for Disease Control in 
Atlanta wrote in the New England 
Journal of Medicine, "Every drug that 
ha'i been subjected to a properly 
controlled trial in genital herpes has 
proved to be ineffective. "7 

The current aim in finding a cure is 
10 stop the herpes virus from becoming 
latent, or from reaching the ganglia 
where it remains for the duration of a 
patient's life; this means that whatever 
treatment i.. going to be tried, speed i.. 
important, and patients must seek 
treatment as soon a.. possible. 

e the herpes simplex virus is 
neurotropic, it can remain inside the 
ganglion of nerve tissue in a latent state. 
and recur again at any time. It is not clear 
what precipitates recurrence - stres'i, 
illness, menstruation - but about half of 
all patients with genital herpes 
experience some form. The lesions may 
reappear once every six months, or once 
a month. 

Figure two: Recurrence 




DWRrams are schematic 

Special danger 
Genital herpes is an especially dangerous 
infection for a number of reasons. It 
spreads rapidly and unlike other diseases 
spread by sexual contact, cannot be 
stopped or cured with a course of 
antibiotics. There are dangers especially 
to women: there is a one in three chance 
that a woman who contracts genital 
herpes while pregnant will abort: the 
virus can spread to the fetus at delivery 
from the vagina, so Caesarean delivery is 
indicated for women who have either 
active or recurring cases of genital 
herpes. 8 lnfants delivered from women 
who have genital herpes lesions should 
be isolated in the nursery for 10 to 12 
Herpes in the neonate is, in one 
doctor's words, "devastating" .IOThe 
herpes simplex virus is also a causative 
organism in encephalomyelitis, II and the 
newborn infant is especially susceptible. 
The virus attacks the baby's entire 
nervous system, and death can result. 

The Canadian Nuree 

Much ha.. been written about a 
possible connection between genital 
herpes and cervical cancer in women. 
ba'ied on certain animal studies. 
Aithough it is true that the majority of 
women who have genital herpes do have 
cervical involvement, one phy..ician 
suggests that both herpes and cancer are 
"co-variables of a certain sexual 
lifestyle",'2 and that one does not 
necessarily cause the other. Still, it is 
recommended that women with a history 
of genital herpe'i have regular Pap 
..mears done. 

Herpes and the nurse 
One might ask, what can a nurse do to 
help people who have this disease when 
there is no adequate treatment and even 
doctors are at a loss to help their 
patients? That, according to Dr. Ian 
Tummon. a resident in gynecology at the 
Ottawa General Hospital who is doing 
research with herpes patients. is exactly 
the reason why nurses are so important. 
"People with genital herpes have special 
emotional problems," Dr. Tummon 
says, and he adds that due to the 
depressing prognosis ofrecurrence 
without treatment, and the means of 
transmission of the disease. "these 
people need a lot of support and 
reassurance." He said that it might be of 
help to patients for them "just to know 
that you know they're suffering. " 
A patient might feel that her having 
contracted genital herpes means that she 
is "paying" for having had a casual 
sexual encounter; there may be strong 
feelings of anger and hurt directed 
against the person who 'gave' her the 
virus. One patient, whose herpes recurs 
every month with her menstrual period 
said, "Every time I get it I don't know 
whether 10 kill myself or to find Richard 
and kill him." One must not forget too 
that these patients suffer from the stigma 
of having a 'social disease', and that they 
have to guard forever after against giving 
it to other partners. 'This is difficult," 
Dr. Tummon points out, because 
admitting that one has an infectious 
venereal disease means they run the risk 
ofIosing the relationship. "But if you 
care about someone," he says. "they 
have to be told."' 
Another problem according to Dr. 
Tummon exists in the relationship where 
both people have genital herpes. "If 
each partner has recurrence once a 
month at different times, that means no 
intercourse for perhaps ten days, which 
means out of every month there are 20 
days when they can't have a normal 
sexual relationship." 

January 1980 23 

Dr. Tummon cautions both nurses 
and doctors against beingjudgmental of 
genital herpes patients; they're suffering 
enough. He says the role of both nurses 
and physicians is to be supportive, 
well-informed, and to urge people to 
seek diagnosis and treatment as soon as 
possible when herpes first appears. .., 

I Blough, Herbert. Successful 
treatment of human genital herpes 
infections with 2-Deoxy-D-glucose, by 
Herbert Blough and RobertGuintolio 
JAMA 241:26:2798-280I,Jun.29, 1979. 
2 Persad, Ralph. The new venereal 
disease. Health 45:1:16, 24-25, Spring 
3 Ibid. 
4 Blough,op.cit. 
5 Ibid. 
6 Donsky, HowardJ. Nonoxynol 9 
cream for genital herpes simplex . New 
Eng.J.Med. 300:7:371, Feb.15, 1979. 
7 Goodheart, G. L. Treatment of 
genital herpes simplex, byG.L. 
Goodheart and M. Guinan. New 
Eng.J.Med. 300:23:I338,Jun.7, 1979. 
8 Blough,op.cit. 
9 Check, William A. Route of 
herpesvirus spread traced with aid of 
DNA-cleaving enzymes.JAMA 
242:7:591-593, Aug.17, 1979. 
10 Donsky,op.cit. 
II Koenig, Harold. Post-infectious 
encephalomyelitis after successful 
treatment of herpes simplex encephalitis 
with adenine arabinoside, by Harold 
Koenig et al. New Eng.J.Med. 
300:19:1089-1093, May 10, 1979. 
12 Tummon, Dr. Ian. Interview at 
Ottawa General Hospital, Sep.19, 1979 

Jane Bock is an assistant editor at CNJ. 

Gratefully acknowledged is the 
assistance of Dr. Ian Tummon, resident 
in gynecology at the University of 

24 Januery 11180 

VIRUS: Pirate in the body 

What are viruses, and how do they differ from other disease-causing organisms? Why 
haven't scientists been able to find a 'cure' for the common cold? 
Viruses are the smallest known living organisms; they affect plants, animals, and 
even bacteria to cause infectious diseases. They vary considerably in size and appear in 
various shapes but generally the viruses that affect man are spherical (see photo). 
Viruses that are agents of infectious disease are what is known as 'obligatory cellular 
diseases', which means that they cannot live and reproduce outside a cell. 
The cells of plants and animals possess both RNA and DNA in their chromosomes - 
true viruses contain only one, either DNA or RNA. 

Life cycle 
When a virus invades the human body, it attacks and actually parasitizes a susceptible 
cell. The virus, which is enclosed by a protein coat, attaches itself to the cell and strips off 
its coat as it enters the host cell. What happens next is an act of piracy - the virus 
shanghais the host cell into doing its metabolic work to form new virus particles. Because 
the virus has only one of DNA or RNA, the viral nucleic acid combines with the nucleic 
acid of the host cell; the virus can multiply only within the host cell. As a by-product of this 
process, the host cell is rendered immune - it cannot be reinfected by the same or 
related type of virus. 
New viral particles are released, and groups of mature viruses escape from the host 
cell. For example, a host cell parasitized by poliovirus can produce 100.000 new 
poliovirus particles in a few hours. The new viruses can survive outside the cell until they 
reach new host cells, where the reproductive process once again begins. 

The disease symptoms of viral invasion are the result of cell injury. Many viral infections 
are silent and show no signs of existence, while others, such as the herpes simplex virus, 
may be latent and appear or reappear long after the initial infection. 
Some viruses can cause the host cells to reproduce in ways which are not normal cell 
reproduction, which gives rise to the theory that viruses are a possible cause of cancer. Of 
the 550 known viruses, approximately 200 cause 50 diseases in humans, some of which 
are extremely communicable and life-threatening. 

Viruses may spread from one human to another directly through contact, as in the herpes 
simplex virus, or indirectly in nose or throat secretions (the common cold), or in fecal 
material (hepatitis). 
Other types of infection may be transmitted in water or food such as poliomyelitis and 
hepatitis, or by insects such as the mosquito which may carry equine encephalitis. 

After some types of viral infection, such as the diseases of childhood - mumps and 
measles - the human body develops a permanent immunity to the virus. For others, 
there is no immunity, as in the common cold. The mechanism by which the body resists 
viral infections is poorly understood, but involves a substance called interferon, which 
serves as a sort of blocking agent. Interferon actually stops the synthesis of the viral 
nucleic acid by some means; because of the theoretical importance of viruses in the 
development of cancer. cancer researchers are very interested in the action of interferon 

Viruses can be destroyed by several other means: high heat for example, or 
formaJdyhyde, hydrochloric acid, elemental iodine, phenol, radiation and ultra-violet light 
all have some effect on various viruses. To prevent viral infection, normal methods of 
sterilization are effective - influenza viruses for instance can be simply washed off the 
hands with warm water and soap before they infect the body. Immunization is an 
important means to control viral infections such as measles, smallpox and polio. 
Of great Importance to all health professionals is the fact that except to treat 
bacterial complications that may be secondary to viral diseases, antibiotic or 
antimicrobial drugs have no effect on viruses. 

Source: Principles of microbiology by Alice L. Smith, 8th ed., St. LOUIS, Mosby, 1977. 

The Canadian Nur.. 

A nurse's package of skills and knowledge has to be portable, as every nurse knows, and nothing is 
_of more value in sorting out the chaos of a home care assignment than a basic nursing care plan. 

Nursing Care Plans and 
the Private Duty 
Home Ca ..,.,,' Patient 

Connie Eaton 

In the spring of this year I was 
summoned to my first private duty home 
care patient. Wearing a pale 
lemon-colored uniform, white stocking
and sensible shoes, I sallied forth. I was 
pleased to be able to do some nursing on 
home ground. so to speak. even though 
my only information was my patient's 
name, age and phone number- it would 
be a bit like public health nursing, I 
thought, where one ventures out to make 
the kind of discoveries and observations 
that most people think only detectives 
are trained to do! 
Armed wi,h my purse and plastic 
shopping bag containing the agency's 
guidelines and policies, I arrived at the 
house - and found no one there! I am a 
fairly resourceful person and not one to 
give up easily, so I did what any normal 
public health nurse would do in such a 
situation: down the street I saw two 
women chatting and I decided to 
approach them about the use of a 
telephone, hoping at the same time that I 
might glean a little information about the 
house and family I was visiting. The 
women were discussing gardening as I 
approached, and apparently thought I 
was either a missionary or the Avon lady 
because they began to retreat to the 
house. I caught up with them and asked 
to use the telephone explaining that I was 
a registered nurse trying to locate a 
patient on the street. The one woman 
laughed then, saying it was obvious I was 
a nurse, intimating by her tone that no 
one else in their right mind would dress 
up in such a costume. I made two phone 
calls and was assured by my agency that 
I was indeed in the right place, that my 
patient was being delivered home shortly 
by her two sons after a visit to her 


I returned to the house and 
introduced myself to the patient's sons 
who in turn introduced me to their 
mother. Another son and daughter-in-law 
arrived on the scene and before long all 
were talking and trying to put together 
the chain of events that had necessitated 
home nursing care and, in fact, crisis 
intervention. I admit to becoming a little 
confused trying to sort out the fragments 
of five people's conversation, and as it 
was by now supper time, things like 
'Initial Assessment' and 'Nursing 
Objectives' seemed relatively 
unimportant next to the task at hand. 

The Canadian Nur.. 

I did gather that my patient, Mrs. P., 
was 65 years old. that she had been a 
widow for just over a year and that she 
had one son living at home who needed 
to be fed daily on his return home from 
work. I also learned that my patient had 
been depressed for some time, had been 
self-administering a number of 
medications. had fallen at home the week 
before and again while out shopping a 
few days ago, thereby fracturing her jaw. 
My patient and her son insisted on 
having steak cooked for dinner and so, 
not wanting to be disagreeable by 
wondering aloud how someone with a 
broken jaw could chew meat, I 
acquiesced. I decided to share the salad I 
had brought - spinach, tomatoes, 
mushrooms and cheese - with my 
patient. and I was not surprised to learn 
that she enjoyed it more than the meat. 
At least it was easier to chew! 
Next came the business of sorting 
out my patient's medications, which 
made up quite an assortment: 
 I tablet daily, Lanoxin<IÞ 
0.125 mg daily, Inderal:!ò I tab. b.i.d., 
Cogentinl' I tab. daily. There were 
immediate orders to discontinue the 
Cogentin, and to gradually reduce the 
I nderal over a period of several days. 
H oS. sedation was Nozinan
 12.5 mg and 
imipramine 50 mg. 
Examining my patient's medication 
regime I was able to postulate that she 
had a heart condition, required a diuretic 
and a tranquillizer. an anti-depressant 
and an anti-Parkinson's agent. I thought 
that aside from giving the medications, 
my main duty with this patient would be 
to observe her, and attempt to help her 
meet basic human needs. 

January 1980 25 

For instance, the family did not 
know when Mrs. P. had last had a bath. 
In any case, she did not want to have 
one. not that first night anyway, so, did 
not pursue the issue. As far as' was 
concerned, it would be best to wait until 
she indicated some willingness to have a 
bath, and that would be in her own good 
Yet another problem was apparent 
from the beginning: the need to keep 
records. As lhere were to be nurses in 
the home around the clock, continuity of 
care was important. and this meant 
sharing information as to what kind of 
things were being done, with what 
responses from the patient. Given that 
Mrs. P.'s problems seemed to be 
predominately psychiatric in nature, this 
was of added importance. 
But, as far as' could determine. the 
agency had no particular forms for 
medications. nursing progress notes or 
patient care plans. My responsibility to 
the agency was to submit a weekly 
progress summary and time sheet. I wa!> 
provided with Guidelines for Home Care 
and a Code of Ethics...period. 
My patient went to bed and while' 
sat in the adjoining sitting room to see 
that she did not get up unattended,. 
thought about the nursing challenge that 
this patient presented. Here was an 
opportunity for independent functioning, 
decision-making, and accountability - 
all dependent on the formulation of a 
patient care plan! 
During the next several days,' made 
my observations of the patient and her 
situation prior to an assessment. , 
re-read the College of Nurses of 
Ontario's Standards for Nursing Practice 
and noticed the inclusion of a specimen 
patient care plan. Once' had the 
guidelines drawn up,' was able to 
quickly formulate a care plan for Mrs. P. 
The agency made several copies of this 
and none of the other nurses involved in 
Mrs. Po's care had any alterations Or 
counter-proposals to make. 
Progress notes recording each day's 
activities had to be left in the home to be 
available to each nurse; this meant the 
notes were available to the family and 
the patient as well. I know that the family 
did read the notes since on one occasion 
someone corrected a spelling error and a 
fact of the patient's history- 
presumably to set us straight! 
The total length of time this patient 
required home nursing care was five 
weeks; nurses wore street clothes when 
it was considered appropriate. The night 
shift was dispensed with after nine days 
and after four weeks only one nurse. 
working a split shift, was required for 
Mrs. P.'s care. 

26 Januery 1980 

Realizing nursing objectives 
Independence lInd lIutonomy 
From the second day of home care the 
patient wa.. able to make decisions about 
meal planning and cooking, although 
initially with supervision. Her judgment 
regarding mobility however was poor 
and she had to be prevented from going 
down the basement steps alone. She 
needed constant reminding too to change 
her position slowly, as she experienced 
dizziness after moving quickly. 
Normally being a very independent lady, 
used to making her own decisions, it was 
important to reassure her that the nurses' 
watchfulness was not a reflection of her 
incapability, but rather a concern for her 
She had no recall of her accidental 
fall or injury; her memory began to 
improve after the tenth day and she 
began to ask questions about the 
experience. By the end of the second 
week of care she was able to write 
cheques and pay bills. She had made a 
hair appointment on her own by the third 
week. and assisted in baking at the end of 
the montho At this time too she initiated a 
visit to a friend's home, and was able to 
travel there and back on the bus, alone. 

Grooming and appearance 
At first, Mrso P. had no interest in the 
selection of her clothes although she 
always commented on the nurses' 
clothing and appearance. She would put 
on a dress but without belt, and when the 
belt was located for her, she would 
fasten it in place with a paper clip. 
However, it was observed that whenever 
she was going to visit her doctor she 
made an extra effort with her 
appearance. Gradually she showed more 
interest in dress choice, and in applying 
light make-up. She was uninterested in 
looking at new clothes, saying "I can't 
be bothered." 

Regular, small attractive meals were 
planned daily for Mrs. P., using informal 
table settings in the kitchen. It was noted 
that she was more inclined to eat 
properly when she had company; her 
poor eating habits of the past few months 
were likely due to her depressed state 
and, more recently, to her constipation 
and lack of exercise. Roughage and fresh 
fruits were encouraged daily: prunes, 
whole grain cereals, fresh fruit and 
vegetables and plenty offruitjuice. 
As the mother of a large family, it 
appeared she had always enjoyed being a 
provider of wholesome meals; she was 
less interested in providing for herself 

The C.na I.n Nur.. 

Due to her memory loss. Mrs. P. had no 
recollection of the frequency of her 
bowel movements; she complained of 
abdominal fullness and nurse!> suspected 
..he was impacted. We informed the 
physician on the second day and he 
ordered Dulcolax'
 suppositories which 
were not effective. On the fifth day he 
examined her and diagnosed a bowel 
impaction for which he ordered enemas. 
It wasn't really until the 11th day when 
preparation for a barium enema was 
given that her bowels started to move. 
She was finally started on Metamucil<R , 
one tsp. daily injuice, to be taken until 
normal bowel function returned. 

Cure a/skin, nails and hair 
On the second day a tub bath was taken 
with supervision. As the patient was 
observed to have very dry skin, baths 
were taken subsequently every two to 
three days rather than daily. She 
accepted hair and scalp treatment for 
encrustation at the end of the first week, 
and required several more treatments. 
After this she preferred to go to her 
hairdresser. Her toenails had grown 
unchecked into large horny curved 
growths, and an appointment with a 
chiropodist was made. 

Mrs. P. had a history of a disturbed 
sleeping pattern for a number of years, 
and she tended to sleep a lot during the 
day. It was not possible to interest her in 
relaxation exercises, nor in quiet music 
or reading before bed. Various sedatives 
were prescribed for her by her 
psychiatrist. and she eventually settled 
on Dalmane@ 15 mg which was at least 
helpful, if not totally effective. She said 
lhat noises outside disturbed her, or that 
she began "thinking of things" , which 
interfered with her sleep. She was 
encouraged to sleep less during the day, 
and was happy with a rest on the bed. 

Actil'ity allli exercise 
Mrs. P. had always enjoyed the outdoors 
and walking, so accompanied walks were 
commenced by the fifth day of care. It 
was difficult to assess, bearing in mind 
her hypertension and irregular pulse 
rate, how much activity could be 
tolerated; she was not pushed. and 
gradually began to take longer walks 
each day, often with a purpose in mind 
such as visiting a friend, and she began to 
feel and look better. 

Needs Problems Nursing Actions Expected Outcome 
Independence and autonomy -short term memory loss Encourage participation in increased independence (eg. 
-physical weakness planning and care. unaccompanied outings) 
Encourage independent action 
when ready. 
Nutrition loss of appetite due to depression Use meals to structure day. Improved appetite 
Plan small, attractive meals of better nutrition 
good nutritive value. 
Elimination constipation and bowel impaction Give medication as ordered by return to normal bowel function 
Encourage roughage etc. in diet, 
and exercise. 
Grooming and appearance: depression- neglect baths q2 or 3 days improved skin, and Interest in 
-skin dry skin use of lotions, creams etc. personal hygiene 
-nails toe-nails overgrown good diet. patient responsible for regular hair 
-hair neglect scalp encrustation make app't for chiropodist care 
shampoos and oil massage interest in appearance increases 
Sleep depression-disturbed sleep Give sedatives as ordered. 
pattern Discourage sleep during day. 
Encourage physical activity. 
Exercise and activity depression-loss of interest Accompany on outings of improved general health and 
increasing length. interest In external world 
Encourage quiet purposeful 
Depression difficulty with expression of Encourage gradual ventilation by return to self-sufficiency and 
, anxieties and sadness lead to establishment of trusting, friendly interest in others. 
inversion relationship. 

During the first two weeks, verbal 
communication was restricted to 
planning daily activities: her affect wa<; 
mainly flat. her facial expression sad, 
and she looked extremely tired for a 
period of four weeks. Her level of 
communication varied with each of the 
nurses involved in her care. but 
gradually she began to express some of 
her feelings. She was concerned most 
about the recent deaths of three close 
family members, and agreed that she 
tended to "bottle things up" rather than 
share with her family. She said she had 
recognized some time ago that she 
needed help in coping with her situation, 
but was unable to make the effort. It was 
observed however that whenever 
members of her family asked how she 
was, she would quickly give a trivial 
answer and change the subject. 
Her need for companionship was 
discussed and she recognized that the 
fact one son was living at home, although 
not often around to be company, meant 
she was not entirely alone at homeoln a 
rare show of assertiveness, she said she 
was not prepared to wait on him hand 
and foot. 

Mrs. P. was a challenging patient 
because it was readily apparent that 
while she would not likely change her 
lifestyle to any great extent, she needed 
some assistance to get her life back on 
the rails. as it were. While she could not 
change her personality to become more 
assertive, she was interested in learning 
more about her medical care at least. 

Signing off 
I feel Mrs. P.'s case emphasizes several 
points about care of a patient within the 
home. First, rehabilitation of a patient 
tends to start immediately in familiar 
surroundings, and a patient seems able to 
function more independently in a familiar 
role. It is easier for the family too to take 
part in the care and rehabilitation 
One might speculate too about the 
cost factor: in Mrs. P. 's case, her short 
term inability to care for herself and her 
depression might have required a stay in 
hospital, followed by a period of assisted 
care and rehabilitation. Home care in 
this case provided an economical and 
feasible alternative to 

The Canadian Nur.. 

In any case, it is clear that in the 
situation where a private nursing agency 
does not provide guidelines as to goals 
and objectives in patient care, especially 
in the home, the basic Nursing Care Plan 
is of invaluable assismnce to the nurse 
seeking to organize priorities of care. 'iii 

Connie Eaton,R.No, has been lIursing 
for more thl/n thirty years since her 
graduation in Lancashire, England. 
Mrs. Eaton has Ih'ed in Canada since 
1963 and has held a \'Griet)' of positions 
ranging from public health nurse in 
N m'a Scotia and 0 ntario to psychiatric 
staff nurse. She returned to England to 
practice nursing in the fall of 1979. 

1 College of Nurses of Ontario. 
Standards of nursing practice:for 
registered nurses and registered nursing 
assistants. Rev.ed. Toronto, 1979. p.19. 
2 Silverthorn, Alida. Nursing care 
plans: a vital tool. Canad.Nurse 
75:3:36-39, Mar. 1979. 
3 Goffman, Erving. Presentation of 
selfin e
'eryday lifeo New York, 
Overlook Press, 19730 

Januery 1980 27 


N elly York 
Deborah Cowan 

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28 Januarv 1980 

The C..nødllln Nurs. 

Mrs. Stewart was a prime 
candidate for application of 
the halo cervical traction 
device. In the two months 
that she wore her tiara, we 
learned a lot about handling 
the special problems of 
patients who are in halo 
brace traction. 

Halo cervical traction is a device 
consisting of a circular metal band 
screwed into the skull to which metal 
rods are attached: the rods are attached 
to a cast or ajacket worn on the patient's 
trunk. The halo traction device provides 
rigid stabilization while allowing early 
mobilization, thus preventing many of 
the complications that result from the 
prolonged immobilization of orthopedic 
Halo traction is used for 
stabilization after: 
. fusion of unstable cervical spine 
injuries secondary to trauma 
· extensive fusion of cervical, 
thoracic or lumbar spine with associated 
. osteotomy and revision of previous 
spinal fusion sites 
. Jefferson fracture 
. fracture of the atlas 
. decompressive laminectomy. 
There may be variations in the halo 
apparatus in that it may be used with 
either a cast frame or a brace frame fitted 
over the trunk, and the frame may be 
extended to the pelvic girdle, depending 
on the area of the spine that requires 
stabilization. Basically however, the 
halo brace is as described briefly above: 
the aluminum 'tiara' is fixed to the 
cranium with four threaded pins. two 
anterior and two posterior. When the 
halo itself is tightened into position, the 
fitted brace is applied and positioned 
with the anterior and posterior rods 
which join laterally at the shoulder, and 
with the transverse rods which extend 
upward tojoin the halo (see photo); the 
rods may be adjusted in three directions. 

Potential complications of use of 
this device include head pin migration in 
which one of the anchoring pins in the 
skull shifts in position and misalignment 
results, local infection at the pin sites, 
and paralysis due to pressure on the 
brachial nerve from the brace. 
Nursing care involves positioning 
the patient in halo traction in such a way 
that there is no pressure exerted on 
either the rod'i or the ring of the halo. In 
addition, care must be taken to avoid 
hitting the rods with anything metallic, as 
the conduction of sound through the 
skull bones is quite uncomfortable. 

A candidate for the halo 
Mrs. Stewart, aged 60, was admitted 
walking to our nursing unit in January, 
with a provisional diagnosis of cervical 
myelopathy and instability associated 
with cervical spondylosis and Swan 
Neck defonnity, S-shaped curvature of 
the cervical spine. It was noted in her 
history that she had had a decompressive 
cervical bilateral laminectomy with the 
removal ofC5, C6, C7 spinous processes 
more than ten years previously for relief 
of a pain syndrome which involved her 
anns. In addition she had had 
enucleation of her right eye perfonned 
more than 30 years previously, due to 
glaucoma. She described a ten-year 
history of progressive neck pain and 
cervical fatigue with weakness and 
numbness in her legs. 
Mrs. Stewart's presenting 
symptoms on admission were right leg 
numbness, a right foot which felt cool to 
touch, episodic right ann weakness with 
a limited range of motion, occasional 
dizziness and even "blackouts", 
Intennittent urinary incontinence was 
also a problem. She told the admitting 
nurse that her condition had become 
increasingly worse over the past three 
Admission blood tests and urinalysis 
revealed results within nonnallimits, 
and after consultation with a 
neurosurgeon a cervical myelogram was 
ordered. Findings of radiological 
investigations of Mrs. Stewart's cervical 
spine were: 
. narrowing ofC5-6, C6-7, C7-Tl disc 
spaces with partial fusion of C6-7 and 

. narrowing of the anterior-posterior 
diameter at the C6-7level and as'iociated 
distortion of the spinal saC with the cord 
resting anteriorly again'it C5-6, C6-7 
. cervical lordosis centered at C6 
. degenerative disc disea'ie detected 
at the lumbar-sacral level: possibly a 
factor in Mrso Stewart's occasional 
urinary incontinence. 
Together in consultation, the 
orthopedic and neurosurgeons went over 
Mrs. Stewart's history and test results, 
and confinned her diagnosis as being a 
combination of cervical myelopathy 
aggravated by kyphosis, 
post-laminectomy kyphosis, and Swan 
Neck defonnity which resulted in a 
kinking of the vertebral artery 
manifesting in dizziness. 

The doctors discussed their findings with 
Mrs. Stewart and she agreed to the 
course of treatment they recommended. 
This was to be two weeks of intermittent 
cervical traction to decrease the 
kyphosis followed by surgery to fuse 
anteriorly C5 to T I with possible 
decompression of C5-6. and 
immobilization post-operatively. 
Two weeks after admission, Mrs. 
Stewart's chest circumference was 
measured for her halo vest. Five pounds 
of cervical halter traction was applied, 
with four inch blocks placed under the 
bed to provide counter traction. 
Nursing priorities at this time 
included teaching Mrs. Stewart the 
importance oflying flat while in traction, 
without pillows. 'Log-rolling' was used 
every two hours so we could give good 
skin care, and bony prominences were 
carefully observed for signs of pressure. 
In a cervical halter, these sites included 
her mandible, ears, and the sides and 
back of her head. The traction and 
weights were checked frequently to 
ensure proper alignment. 
Mrs. Stewart was allowed to remove 
the halter at meal times when deep 
breathing and coughing routines were 
On the whole, Mrs. Stewart 
tolerated the cervical traction poorly due 
to increasing neck pain and severe 

The Cenedlen Nur.. 

headaches. She a'iked for the halter to be 
removed often, and she required 
increasing amounts of analgesia. After 
five days, the doctors ordered the 
traction reduced to three pounds. but 
this gave only minimal relief of pain. 
After a week we began to ambulate her 
to promote lower limb strength and 
circulation pre-operdtively. She 
continued to use the halter traction, but 
she was encouraged now to use pillows 
under her shoulders to hyperextend her 
neck. This measure provided comfort 
and actually maximized the effect of the 
traction on the cervical spine. 
The doctors discussed the halo 
traction apparatus with both Mrs. 
Stewart and her family, and she decided 
to accept this form of treatment 
following surgery for cervical fusion. 

Wearing a halo 
After nearly a month in hospital Mrso 
Stewart went to the O.R. for application 
of the halo cervical traction under a local 
anesthetic. Seven pounds of traction 
were applied immediately, and increased 
to ten pounds the next day to increase 
neck extension. 
:'vlrso Stewart was now on complete 
bedrest and had folded towels and small 
pillows positioned behind her shoulders. 
Positioning the pillows was tricky: one 
was at the back of her neck and the other 
under her head, leaving space for the 
halo pins while at the same time 
preventing her head from resting on the 
bed. Counter traction was provided by 
elevating the head of the bed on four inch 
We nursed Mrs. Stewart in the 
supine position at this time,log-rolling 
her for skin care and positioning her on 
her side for meals. The cervical traction 
was reduced after a time to seven pounds 
to prevent hyper-extension and to 
promote comfort. Two days before 
surgery the halo vest was applied and 
Mrs. Stewart was ambulated wearing the 
whole brace to familiarize her with the 
apparatus, and to decrease her anxiety, 
The first week of February Mrs. 
Stewart underwent an anterior spinal 
fusion ofC5-C6-C7 in the O.R., after 
which the halo cervical traction was 
reapplied. Traction weight was started at 
two pounds then increased to five and 
again to ten within hours. 

Jenuery 11180 211 


Post-op care 
Immediately after surgery, nursing care 
included frequent neurological 
assessments, checking for movement 
and sensation in Mrs. Stewart's 
extremities, and monitoring of her vital 
signs. Intravenous therapy was 
continued for three days post-op until 
Mrs. Stewart's oral fluid intake was 
The third post-op day she began to 
complain of an extremely sore throat 
with a periodic "choking" sensation: a 
throat swab sent for culture and 
sensitivity and gram stain was negative, 
so she was treated symptomatically with 
elevation of the head of her bed 30 
degrees, the use of throat lozenges, sips 
of fluids progressing to soft foods, and 
crushed or liquid medications. 
Again, log-rolling Was done every 
two hours for skin care routine and to 
allow for use of a slipper bedpan. Chest 
physiotherapy was being given at this 
time, and the nursing staff encouraged 
frequent deep breathing and coughing. 
Passive and active exercises were 
provided in order to maintain good 
circulation and muscle tone. 
Mrs. Stewart was encouraged to 
drink 3000 cc's of fluids daily, and she 
required a bowel routine to prevent 
The fourth post-operative day Mrs. 
Stewart's cervical traction was 
discontinued and the halo vest apparatus 
was reapplied and correctly adjusted. 

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30 Jenuary 1980 The Cenadlan Nuree 

Our patient was transferred to the 
convalescent rehabilitation unit for 
ambulation and preparation for the 
activities of daily living. Ambulation was 
initiated by providing proper positioning 
of Mrs. Stewart's head and neck while in 
a high Fowler's position in bed. From 
here she went to a high back recliner 
wheelchair (using a standing transfer 
method), with pillows to support her 
back, sides and anns.lnitially she was 
up for just five minutes, but this was 
increased every two days by five to ten 
minutes, as tolerated. At first she found 
it uncomfortable to sit in the high 

Fowler's position, due to the halo 
apparatus, but gradually her tolerance 
increased. With the use of supporting 
pillows she was eventually able to sit up 
for two hours at a time. 
With the increased activity. Mrs. 
Stewart's previous bowel constipalion 
became less of a problem. She -;tarted to 
use the commode chair too which 
ensured complete emptying of her 
bladder but she remained apprehensive 
about incontinence. 

T eClm nursing 
We held a team conference to discuss 
Mrs. Stewart's problems. In caring for 
her, we had ascertained that these 
included a difficulty with feeding, a need 
for increased ambulation, apprehension 
about urinary incontinence, and a need 
for some teaching about the care of her 
eye prosthesi
.ln addition, there was a 
problem with use of the bedpan, due to 
her fear of being incontinent; Mrs. 
Stewart would sit on the pan for long 
periods of time, and we feared that 
decubiti would result if this practice 
continued. During the day, we removed 
the bedpan from her reach, making it 
necessary for her to call for assistance. 
Then she was ambulated to a commode 
with two nurses helping. 
We increased her walking time each 
day, and we used even short walks to the 
bathroom to progressively increase the 
amount of her activity. Gradually, as her 
strength and bladder control returned 
she was able to get up with only one 
person for support, and then by herself. 
In order to assist Mrs. Stewart at 
feeding time and to help her regain her 
independence, we positioned her at 
mealtimes in the high Fowler's position 
and arranged her food tray so that all her 
food was in full view; she had difficulty 
drinking from a cup so we gave her a 
straw. Here too her strength and 
co-ordination increased, and soon she 
was virtually independent at meals. 
Dressing was another problem for 
Mrs. Stewart, we knew, but fortunately 
she was able to obtain loose-necked 
nighties from her family, and later 
blouses, so that she could dress herself 
with a minimum of a'isistance. While the 
halo brace was in place, we used dry 
shampoo to keep her hair clean, and we 

combed her hair for her. Skin care was a 
priority in our discussion as even with 
increased ambulation. Mrs. Stewart 
developed pressure sores on her 
scapulae which were relieved with the 
e of padding and skin ointment. 
Physiotherapists were teaching Mrs. 
Stewart range of motion exercises for her 
arms, using the 'patient helper' for 
pull-ups and weight-lifting to increase 
ann mu
c1e strength. She had a problem 
of tilting backward when walking which 
was corrected by the use of parallel bars 
and a mirror in the physiotherapy room. 
Nursing staff were aware of the physio 
program and reinforced the exercises 
and her need for correct pO'ilure 
whenever we ambulated our patient. 
We discussed the Slewart family 
and their relationship to Mrs. Stewart; 
she had two sons and a daughter as well 
as her husband. Her family was very 
supportive and concerned about her 
health, visiting frequently. They were 
able to give her a good deal of 
stimulation by taking her for short trips 
to the hospital cafeteria, and touring 
other areas of the hospital. Near to the 
time of her discharge Mrs. Stewart was 
able to go out oflhe hospital on weekend 
passes to visit her son who lived in 

Going home 
Nearly two months after the halo had 
been applied, Mrs. Stewart's halo brace 
traction was removed, and a fitted 
plastizode collar was put on in its place. 
Once the tiara was removed Mrs. 
Stewart was totally independent and able 
to walk with onl y a cane for assistance. 
Teaching for discharge included 
instructions to avoid long rides in a car, 
not to do any lifting, and to generally 
beware of any flexion or extension of her 
spine. She was taught to turn her whole 
body instead of just her head, and to 
avoid any jerky movements. We asked 
her to continue to do her 
muscle-strengthening exercises and to 
watch her posture; she had to wearthe 
cervical collar at all times, except when 
lying down, and she would have to keep 
it for three to six months. 

The Cenadlen Nuree 

Mrs. Stewart was discharged after 
II weeks in hospital and went to live 
with her son until she was well enough to 
make the trip home to her husband in 
H.C. We didn't see her again until the 
summer when .,he came in to see her 
doctor and she visited the unit where she 
had spent so long working toward her 
goal- she wore no collar and was 
happy, independent and strong.... 

I *Harrel. Thompson. The halo 
lraction apparalus - a method of external 
splinting of the ceNical spine after injury. 
J.BoneJoint Surg. 44B-3:653-67 I. Aug. 
2 *Nickel. V.L. The halo. byV.L. 
Nickel et aI.J.BoneJoint Surg. 
5QA.: 1400-1409, 19(,8. 
3 Patient chart. 
4 Prolo, J. The injured ceNical spine: 
immediate and long tenn immobilization 
with the halo, by Dol. Prolo et al.JAMA 
5 T aher's cyclopaedic medical 
dictionary. 12th ed. Edited by Clayton L. 
Thomas. Philadelphia, Davis, 19? 
6 Wilkins, Charles, Cranial neNe 
irUury from the halo traction, by Charles 
Wilkins and G.D. MacEwen. Clin.Drrhop. 
no. 126, p.1 06-11 0, Jul./Aug. 1971. 
7 Zimmerman, Eric. Treatment of 
Jefferson fracture with halo apparatus. 
Report oftwocases.JNeurosurg. 
44: 3:372-375. Mar. 1976. 
8 Zwerling,MT. Use of the halo 
apparatus in acute injuries of the ceNical 
spine, by MoT. Zwerling and R.S. Riggins. 
Surg.Gynecol.Dhsteto 138: 189-193, Feb. 

*U nahle to verify in CNA Library 

Nell)' J. York,RN, and Deborah Cowan, 
RN, are stafJnurses working on the 
orthopedic rehabiLftation unit of the 
Calgary General Hospital. It has 
become apparent in their wor/.. that halo 
cervical traction is a de
'ice being used 
increasinglv for immobili;:.ation in spinal 
i1ÿuries, and they hope their case study is 
of benefit to nurses across Canada. 
Deborah Cowan is a graduate of the 
Mount Royal College in Calgary, and 
Nelly Yorf.. graduatedfrom the Hotel 
Dieu Hospital, St. Joseph's School of 
ing, Kingston, Ontario. 

Jenuery 11180 31 




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Some practical tips on relocation - problems, 
pre-planning, where to stay and who to contact. 

Laura Worthington 
The law of supply and demand is an old 
one in the business world, well 
understood by financial analysts. It is 
only in the last year or two, however, 
that nurses across Canada have begun to 
realize how that law applies to them: too 
many nurses and not enough jobs ! 
Sometimes, in order to remain in 
nursing, relocation seems to be the only 
Since my own move to California a 
year ago I have met and talked to a 
number of displaced Can
dian nurses. 
My friendship with them and my growing 
familiarity with the health care scene in 
Los Angeles have influenced me to write 

POSTSCRIPT:Canadron nunes now 
working or planning to work in the 
U.S. should be aware ofrecent 
changes in the U.S.lmmigraJion 
Service which will require allforeign 
nurses (including Canadrons) to pass 
the screening examination given by the 
Commission on Graduates of Foreign 
Nursing Schools. Filing deadline for 
the next CGFNS exam, in April, 1980, 
has been extendedfrom January 2 to 
January 15,1980. Formore 
infonnaJion, consult CGFNS, 3624 
Market Street, Philadelphro, Pa.19104 
or your provincrol nurses' associations, 
More details in next month's issue of 

32 Jenuery 1880 

this article, hoping it will facilitate the 
planning of anyone with relocation in 

First the bad news 
Let's face it: relocation is not for 
everyone. Many of the Canadians I've 
met in the past year are genuinely 
distressed by their move. Some of this 
unhappiness could have been avoided 
with a little self-insight. 
If you love living in the Northwest 
Territories, love working in a 50-bed 
community hospital in the Canadian 
North. there is about an 80 per cent 
chance your move to .. the biggest 
teaching hospital West of the 
Mississippi" will be a mistake. It may 
not, but chances are pretty good that it 
will. Stick with what you like. If a 
small-town flavor is for you, apply to 
community hospitals. Do you live for the 
first snowfall? Don't go to Palm Springs. 
How many times have I heard "but I 
miss the leaves turning color and the 
snow." Likewise if you come from a 
high powered teaching hospital in 
Toronto you may think that 
one-horse-town in Montana sounds 
wonderful. Better think again! 
A unique environmental problem in 
Southern California is the lack of mass 
transit. You must be able to dri ve and 
have access to a car. It doesn't matter 
that the new hospital where you'll work 
is "five short miles from the beach". It 
might as well be 500 without a car. 

The Cenedlen Nure. 

And by the way, don't believe all 
you read in the ads about the attributes 
ofa specific hospital. Forexample, 
Come work on our teamo You'/[ lore 
the true C alijornia quality of our 
locale. Minutesfrom the beach. 
One nurse who did believe a similar ad 
moved without a pre-visit. and ended up 
being very surprised. She got the large 
teaching center atmosphere she wanted. 
Unfortunately it was in a bad area of 
town, the beach was covered with oil 
riggings, and without a car, she was a 
captive in her hospital housing. There 
may be similar unique problems in the 
community where you wish to go. Do a 
little footwork and find them out before 
you arrive. 
Patients in American hospitals have 
a different outlook on health care from 
that of their Canadian counterparts. 
Most people in the U.S pay large sums 
of money for the health care they 
receive. This makes them consumers in 
the true sense of the word. Be prepared 
for detailed critiques of the food, 
furnishings and medical care 0 Naturally 
this is not true of all people and the 
situation is different at state-funded 
institutions. But it does happen and, if 
you're ready for it, the shock won't be so 

And now the good news 
Whatever your personal reasons and 
thoughts on relocation, the good news is 

that you will be received with open arms 
pretty much wherever you go. Los 
Angeles Sunday papers carry three or 
four pages of job ads for nurses every 
\\<eek. Some of the ploys the hospitals 
u!>e to attract you are: 
. 4-8-12 hour shifts. You can pretty 
much choose but be prepared to start on 
nights. Many hospitals have this policy; 
to be sure, ask what shifts are available 
to new hires. 
. 20 per cent shift differential for night 
work; 15 per cent shift differential for 
PM work_ 
. application to a specific hospital may 
net you: 
-a round trip ticket for an onsite visit 
(especially if you have a specialty or 
management skill). 
-expedition of your visa by the hospital 
after you have signed on. 
-provision for interim housing after you 
arrive at your new job. 

Is a move part of your career future? 
Start planning now! There are lots of 
things to learn and do before you 
consider going anywhere. 

I. Finances 
If you have just enough money in your 
pocket to get to your new destination, 
don't go! Relocating is filled with hidden 
expenses. Most apartment owners in big 
cities require first and last month's rent 
in cash plus a cleaning deposit. In the 
beach communities of Southern 
California that means: $300 (rent per 
month, one bedroom) x 2 (first and last) 
+ $50 (cleaning deposit). This translates 
into $650 that the manager expects in 
cash or money order unless you already 
ha ve your new bank account. (Don't 
count on that, it takes longer than you 
think. See below.) 
Having your Canadian bank wire 
money to the new U.S. one is a safe way 
of money transferral. However it is not 
as speedy as bank officials may claim. [ 
was nearly evicted from my brand new 
San Francisco apartment because the 
money I had wired from Vancouver 
didn't arrive at my new bank in time. 
Would-be landlords are not impressed 
when your first cheque "bounces". 
Do wire large amounts of money 0 
But be sure to take sufficient travellers 
cheques with you to cover expenses 
within the first month of your move. 

2. A place to lay your head 
Nothing is worse than arriving in a 
strange town and not knowing where to 
stay your first night. So arrange this in 
Staying at reasonable 
accommodations for a week or two 
allows you to see the city leisurely before 
you decide on a place to liveo The 

YWCA (or YMCA) is always a cheap 
and usually a good choice. Most Y's are 
situated in the city center which allows 
you to immediately get acquainted with 
your new environs. The only drawback 
to this arrangement is that some 
YWCA's are in the seedier area of 
If the YWCA isn't your style, try 
writing to the department of tourism (or 
city hall if it's a small town) in the city 
you've chosen and ask for hotel 
information. This should help you select 
your first accommodation. 

5. Who to contact 
You mllst contact the nursing association 
in the state where you propose to go: 
through them you will learn about state 
licensure requirements. Obviously this is 
something you do in your planning stage. 
Be sure the state accepts your provincial 
license; if it does not you may be 
required to take the national boards 
exams in the U.S. and/or repeat certain 
parts of your clinical training. (i.e. 
pediatrics, public health, psychiatry). 
And when you arrive all set to work, but 
without a license to practice, this can be 
very upsetting. 

3. A pre-more ,'isit 
As ['ve mentioned, writing ahead to the 
hospital or hospitals of your choice may 
net you a round trip onsite visit; even if it 
doesn't, you should try to go see your 
new locale before you actually move. I 
knew a nurse who left the "mainland" to 
go to Hawaii for an excellent job in 
nursing. This nurse "just knew" she 
would love it there. Unfortunately she 
and her 4,000 pounds of furniture 
returned three weeks later because 
things weren't all she had expected. Save 
yourself that expense - a pre-move visit 
is a crucial step in planning. 
Another way of doing this is to 
attend a medical conference in the city of 
your choice; this gives you a preview of 
what you can expect. You get to see the 
area and rub shoulders with some of your 
future colleagues. Initial work contacts 
can be made at this time too. One side 
benefit - the trip is tax deductible if the 
conference furthers your profession. 

4. Visas 
Arranging for a work visa in the U.S. 
takes a little time since nurses along with 
everyone else are subject to the quota 
system. To start the wheels turning, visit 
or write the American Embassy nearest 
you. If your pre-trip visit has already 
helped you select a hospital and you 
have been assured employment there. 
this can expedite matters 0 Most nurse 
recruiting departments in the U.S. are 
able to help you obtain a work visa and 
entry papers. It is accepted practice for 
them to expect you to sign a work 
contract at that time. 

The Cenedlan Nur.. 

The American Hospital Association 
can supply you with the names of 
teaching and non-teaching facilities 
across the nation. You can learn from 
them the size of the hospital, whether it 
is an acute Cáre facility, and its location. 

Board of Registered Nursing 
1020 N Street 
Sacramento, Calif. 95814 


American Hospital Association 
840 N. Lakeshore Dr. 
Chicago, Illinois 6Oó11 
Once you have the names of the 
hospitals in your new locale you can 
make another contact: the nurse 
recruiter. She will be someone with 
whom you can correspond prior to your 
onsite visit. Through this 
correspondence you can set up an 
interview date, which saves time when 
you do arrive in town. Your nurse 
recruiter will also often get you a packet 
of information-about the hospitals you 
are interested in befere you arrive. This 
Can be a big help in deciding where to 
And last but not least, if you 
correspond with her, the nurse recruiter 
may agree to provide you with 
references. When you "don't know a 
soul" and everyone from the telephone 
company to the landlord wants an 
in-town reference, this can be 

Whatever your reasons, relocation 
should be the best move you can make. 
And, if you know what you want and 
how to get it, it will be. I hope this article 
helps you toward that goal. '" 

Laura Worthington, the author of "Is 
there a move in your future?", is a 
Canadian nurse now working in the 
United States where she is employed by 
Cedars-Sinai Medical Centerin Los 
A ngeles as coordinator of their critical 
care programs. 
Three years ago, when she 
represented the Canadian Nurses 
Association at that year's International 
Conference on Medical Devices in 
Ottawa, her report was featured in the 
October 1977 issue of the Canadian 
Nurse Journal. 
Before moving to California, 
Worthington was nurse clinician in the 
recovery room and ICU of the Royal 
Victoria Hospital in Montreal. A 
graduate of the University of San 
Francisco and of the Uni,'ersity of 
California, where she received her 
Master of Science in cardiopulmonary 
medicine, she has worked in intensive 
care units across Canada and the U.S. 

Januery 1980 33 

role of the 

Jo Logan 
Is equality among our fellow workers destined to be the 
chimera of the nursing profession? Always just beyond our 
grasp? Not content merely to serve the doctor, the nurse 
has now expanded her handmaiden role to include the 
pharmacist, social worker, physiotherapist, occupational 
therapist, dietician...in fact, most of the people she works 
Why? And what to do about it? Is education the 
answer? Perhaps the only answer? I believe it is. 

The role of doctor's handmaiden had some advantages for the 
nurse: everyone knew that a good handmaiden was worth her 
weight in gold.' But times have changed, as have health care 
needs, the educational preparation of other health disciplines 
and the nature of nursing. For awhile it seemed that nursing did 
not want to fulfill the handmaiden role any longer, opting instead 
for a more independent role in the health field. But now it looks 
as though, as a group, nurses are choosing to function as 
handmaidens after all. Of course, in order to meet current 
demands, the handmaiden role is expanding: nurses are now 
providing this service to all members of the health team. 
This has come about because, of all the members of the 
team responsible for direct patient care, the nurse is the least 
educated. As such, she is subject to pressures from outside the 
profession which distract her from practicing in a way that is 
congruent with current nursing expectations. Today's nurse is. in 
fact, inadequately educated to undertake the activities required 
by modern health care standards. 
How can the nurse be considered a professional colleague 
and an equally contributing member of the health team when the 
disparity in their educational preparation is so obvious? Doctors, 
dieticians, physiotherapists, occupational therapists, 
pharmacists or social workers are all educated in a university. 
Even technologists prepared at community colleges consider 
their three-year program superior to most nursing education 
programs and, of course, three years concentration on one 
system does provide a depth of knowledge impossible to 
acquire in a two-year course designed to teach humanistic care 
for a patient who possibly harbors multisystem problems, 
There are some within these groups who think that nursing 
consists of changing soiled linen and believe therefore that 
present nursing education is adequate. In my opinion, based on 
what I witness in my work, nurses do not have any less critical or 
complex decisions to make than many of these other 
professionals. Nursing assessments save lives! 
I am tired of hearing from detractors of nursing. There are 
some uncaring and incompetent nurses in the field but there are 
also many excellent nurses. Given their education and the 
demands of current health care, it is a wonder nurses succeed in 
meeting any patient needs at all. Consider what a nurse is 
expected to accomplish on a medical or surgical ward on an 
average evening shift: 
· juggle the demands of families, doctors and other 
personnel, all of whom have a "me first" attitude 

34 Jenuery 1980 

· coordinate the activities of all her so-called "colleagues" 
· and, almost as an afterthought, plan, implement and 
evaluate care for each and every individual patient in her 
I do not believe that the service provided by nurses is so 
inconsequential that the educational preparation can afford to be 
The magnitude of that which nurses face daily is such that 
they often appear incompetent. This situation is frequently 
exacerbated because other groups tend to judge nurses by 
criteria from their own discipline: nurses do not know as much 
medicine as doctors, nurses do not know as much about 
nutrition as dieticians. They do not even know as much about 
respiratory technology as members of this group. The 
conclusion is that nurses do not know very much about anything 
at all and must be carefully directed; direction is required not 
only on how to implement the orders from other disciplines but 
also on how to function in the area some of us still think of as 
nursing. I have heard a physiotherapist, for example, remind an 
experienced surgical nurse to be sure to let the patient sit on the 
side of the bed for a few minutes before getting up for the first 
time. The nurse smiled graciously if a touch wearily. I have also 
heard a respiratory technologist vehemently insist on a nurse 
giving comfort to a family member; the hassled nurse declined 
because she knew that particular visitor had absolutely no 
connection with her deceased patient. The range of guidance 
seen as necessary for nurses extends from simple physical 
assessment to complex psychosocial interventions. 
Nurses not only serve as handmaidens, they also make 
convenient scapegoats. Errors in patient care have increased 
along with the number of care providers. That nurses should be 
held accountable for the mistakes of other groups ;s one of the 
myths by which we all live. The nurse is the patient's last line of 
defence: she is the final safety filter for any patient therapy. This 
puts the nurse in a position where she must act as an expert in 
every discipline, plus her own. Impossible! 
Unless the nursing profession is going to be content to 
restrict its practice to carrying out delegated functions for other 
groups, we must educate all of our members to a professional 
level. If we do not, the plans of nursing educators and 
administrators for a profession comprised of members able to 
use nursing process with consummate skill will never 
materialize; nursing process is still a fragile concept, easily 
destroyed as real nursing is continuously subordinated to the 
demands of others. 
If basic preparation provided the expertise necessary to 
practice in the manner nurses think appropriate, nursing would 
be in a better position to withstand the distractions created by 
others. Nursing education does not now provide the skills and 
in-depth knowledge nurses need when expectations .....include 
knowledge and skill related to the assessment, planning, 
implementation and evaluation of nursing problems in both 
social-psychological and physiological realms."2 Many studies 
have tried to determine why nurses do not consistently use care 
planning in their practice. One conclusion is that they lack the 
necessary theoretical knowledge. 3 
As nursing research becomes more clinically oriented, it 
creates a science of nursing; nursing students will have to learn 
new concepts which must be incorporated into existing practice. 
In addition, utilizing concepts from other sciences will continue 
to be a necessity for nurses. Although nursing reflects the 
contemporary focus on health, the ability to care for patients in 
acute care agencies will always be essential. How long does it 
take to learn the knowledge, skills and attitudes required by 
existing nursing standards? Whether operating in a community 
milieu, in the mechanized world of critical care or elsewhere on 
the continuum, nursing must provide more depth and 
sophistication to the education of the new practitioner. 
We have failed in our attempt to provide two levels of 
registered nurse practice. Nurses in North America are no 
longer committed to dividing nursing practice into two groups: 

The Canadien Nure. 

the so-called professional/technical split. The professional and 
technical functions of the nurse can be separated in a classroom 
but not while giving care to a patient. McClure laid bare this 
issue with decisive clarity, describing the technical functions as 
an integral part of professional nursing practice.. Schlotfeldt 
agreed, stating that .....technology is an important aspect of all 
professional practice and professional practitioners are 
expected to be highly competent, technically."
Both diploma and degree programs of nursing education 
have been accused of failing to produce a graduate with 
sufficient technical expertise . To pit one type of program against 
another is futile; each was right for its time but that time is past. 
The question now is: how long can experienced nurses continue 
to bridge the ever widening gap between their educational 
preparation and the demands made upon them? How will each 
succeeding year of graduates cope? Can a new graduate 
realistically be expected to manage her own increasing 
responsibilities as well as those imposed upon her by others? 
The nurse educator's lament that nursing administration expects 
too much will grow to a wail as nursing administration valiantly 
tries to keep afloat amid the financial constraints and empire 
building now in vogue in many agencies. 
None of this is to be interpreted as a vindication of some 
previously existing program or as testimony that people with 
university educations are superior people to those with diploma 
or community college credentials' I know that the level of care 
nurses give depends on many things, however, I feel strongly 
that education is one variable over which nurses exercise 
control as a method of defending and strengthening their 
profession. Nurses without university preparation are having to 
utilize every possible means to fiU in the gaps in their education 
and acquire new expertise: many use formal continuing 
educational programs as a method of development; others solve 
the frustrating problems of work by escaping to a university 
setting. choosing a nursing degree in the hope that it wiU lead 
them away from the bedside. A more serious loss to clinical 
nursing is the brain drain of nurses who prefer a professional 
career in some other field. 
University nurses from generic programs present another 
problem: there are those within this group who clearly and 
frequently proclaim their superiority over other nurses. This 
denigration of one nurse by another is destructive and more 
offensive than disparagement by other professionals. 
Paradoxically, these are the very nurses who fail to realize that 
all nurses are perceived as being the same regardless of 
education or experience. 
Basic nursing education must move towards a solution to 
these problems. There must be a shift from the community 
college to the university. But, if currently registered nurses 
regard such a change in educational preparation as a threat 
rather than a necessity for practice and survival, this change will 
be slow to happen. The decision is whether to settle for an 

= i 

" , 

. \ 

expanded handmaiden role or to strive to achieve a professional 
role for all nurses; there cannot be two groups ûf registered 
nurses. We must explore flexible approaches to adding to the 
educational base of each individual. At the same time. we must 
determine methods of providing security for current registrants. 
This is a more valuable use of energy than opposition to such a 
desperately needed change. 
University faculties will have the task of designing a 
curriculum which meets the standards of the real world. Inherent 
in this change is provision for articulating interested registered 
nurses into the university and supplying encouragement for 
them to do so. A realistic program for the education of all nurses 
wiU provide practitioners with the expertise to cope with new 
frontiers of knowledge in all the sciences and the concomitant 
increase in legal and ethical issues. Unified preparation will also 
provide the professional solidarity that is needed for a viable 
support system. 
Community college faculties should assume more 
responsibility in several areas of nursing. Expanding their 
continuing education services would provide all practitioners 
with the information and skiUs to prevent obsolescence. The 
need for refresher courses will increase as nurses continue to 
drop temporarily out of clinical practice and as licensing 
regulations become more rigorous. Community colleges should 
specialize in nursing other than that given at the graduate 
university level. Smoyak states that "specialization is the 
inevitable result of new knowledge within fields and demands 
from the public for new services."6 As medicine becomes more 
specialized, nursing must become likewise specialized; every 
time a doctor initiates a new therapy or surgical procedure, a 
nurse must be present to give expert care, whether the focus is 
on cure or helping the patient to cope. 
The nursing profession in Canada can forestall disaster and 
diminish the external pressures that now threaten the profession 
by making some crucial decisions about educational 
preparation. Nurses need to be better prepared; when their level 
of expertise rises, nurses will be able to resist the handmaiden 
syndrome. As an educator, I would rather teach a nurse to write 
and implement nursing orders than teach her to carry out the 
directions of a multivariate group of professionals and 
The nursing role is expanding but, unless the profession 
educates its people to a sufficient level, nurses functioning in 
this expanded role will grow increasingly subservient, and 
nursing as a profession will never live up to its potential. 'V 

1 Campbell, Gilbert S. Where are the nurses of yesteryear? 
(editorial)Amer.J.Surg. 133:2:145, Feb. 1977. 
2 Bullough, Bonnie. The associate degree: beginning or 
end? Nurs.Outlook 27:5:325, May 1979. 
3 Aspinall, Mary Jo. Nursing diagnosis - the weak link. 
Nurs.Outlook 24:7:433-437, Jul. 1976. 
4 McClure, Margaret L Entry into professional practice: the 
New York proposal. J.Nurs.Admin. 6:5:12-17, Jun. 1976, 
5 Schlotfeldt, Rozella. On the professional status of nursing. 
Nurs.Forum 13:1 :25, Jan. 1974. 
6 Smoyak, Shirley A. Specialization in nursing: from then to 
now. Nurs. Outlook 24:11 :678, Nov. 1976. 

Jo logan, author of "The expanded role of the handmaiden", is 
a guest lecturer at the University of Ottawa and teaches in the 
Vascular Unit, Staff Education, at the Ottawa Civic Hospit;J/. A 
graduate of the Ottawa Civic Hospital, she received her B. Sc. 
N.Ed. and M.Ed. from the University of Ottawa. Her experience 
includes employment as a general staff nurse and assistant 
head nurse at Johns Hopkins Hospital in Baltimore, USA, and 
as a teacher at the Ottawa Civic Hospital School of Nursing and 
Algonquin College School of Nursing. Readers of CNJ may 
remember her previously published article, "The handmaiden is 
not dead" (The Canadian Nurse, May 1976). 

, .....rc.n.dlan Nurse 

Januerv 1980 35 


Alberta. University of 

Aoom 3 - 118 
Clinical Sciences Bldg. 
Edmonton. Alta. T6G 2G3 


Going back to school need not be drudgery: nursing programs today offer a wide 
variety of courses covering many interests as well as the core nursing subjects - 
literature, philosophy, sociology - all these are available. 
For the RN who is interested in upgrading her educational qualifications, CNJ 
has compiled a catalogue of programs - both degree and certificate - available in 
universities across Canada. Of special note is the number of universities now offering 
part-time study. 
Interested nurses should write to the institution of their choice for a calendar and 
further information, and apply early. It is a good idea too to enclose with the 
application a thorough resume of past education and experience. 
Good luck! 



Amy E. Zelmer, PhD 

BScN-2 years (to be completed within 5 
years of admission, one year must be 

Deadline for application 
May 15 

Adv. Practical Obstetrics- 
1 calendar year 

orientation period plus 4 months clinical 

Despite a policy to support university 
level nursing programs. the Government 
of Alberta has refused to fund expansion 
at the University of Alberta. 

BSN-one summer course (May, June, 
July) followed by 2 years 

British Columbia, University of 

2075 Wesbrook Mall 
Vancouver, B.C. 
V6T 1W5 

Calgary, University of 

2920 24th Ave. NW. 
Calgary, Alta. 
T2N 1 N4 

38 Jenuery 1980 

Marilyn D. Willman, PhD 


Margaret Scott-Wright, 

Note: certain courses taken at Athabasca 
University in Edmonton are acceptable 
toward a post-AN degree. For more 
information, contact Athabasca 
University, Box 10001, Edmonton, Alta., 
T5J 2P4. 

Deadline for application 
April 1st 

The C.nadl.n . ..... 


MN 2 years (in acute illness) 

M.Ed. ) 
MA 2 not offered by 
years. Faculty of Nursing 

M.H.S.A. Master of Health 
Services Admin. 
2 years 

diploma in Health Services 

MSN 2 years 
M.Sc (Health Services Planning) 
2 years 

MA IInd M.Ed. 1 year 
EdD - 2 years 

Concordia University BA-specialization in community nursing 
- 90 credits 
7141 Sherbrooke St. West Muriel Uprichard, PhD 
Montréal. P.O. Director Health Ed Certificate community nursing 45 credits 
H4B 1 R6 
Certificate health education 45 credits 
Dalhousie University BN-3 years - part-time study possible MN -1 calendar year 
Halifax, N.S. Margaret L. Bradley Outpost and Public Health Nsg 
B3H 4N8 director 15 months (one year + 28 wk internship 
School of Nursing in North) 
Lakehead University Honors BScN-4 years - RN's may 
challenge certain courses for credit 
Thunder Bay, ant. Margaret Page 
P7B 5E1 director 
School of Nursing 
Laurentian University BScN-2-3 years, depending on success 
of student in challenge exams taken after 
Ramsey Lake Rd. Wendy J. Gerhard 1 year of study in nursing, science, social 
Sudbury, ant. director sciences and humanities. 
P3E 2C6 School of Nursing 
-some part-time courses available: also 
Correspond before in North Bay, Kirkland Lake and New 
.courses available in French August 1980 Liskeard through colleges 
McGill University BScN-3 years (RN's with diplomas from M.Sc. (applied) 2 years 
hospital schools may have to make up 
3506 University Street Joan M. Gilchrist some sciences) M.Sc. (applied) for non-nurses 
Montréal, P.O. director with a BA or B.Sc. 
H3A 2A7 School of Nursing 2 years plus preceding 
qualifying year 
McMaster University MoH.Sc.-3 academic terms, full-time 
-applicants assessed individually; 
Health Sciences Centre baccalaureate degree not necessarily 
1200 Main Street W. required, but applicants must have 
Hamilton, Onto L8S 4J9 successfully completed some university 
credit courses and have at least 2 years 
clinical practice. 
Write:Graduate Program Office, Rm. 3N8 
Pri mary Care Nurse Program-1 
academic year 
-leads to diploma in Primary Care 
-combination of practice and study 
Manitoba, University of BN-4 years MN 2 years-clinical 
RN's may challenge courses for credit in specialization 
Winnipeg, Manitoba June M. Bradley 1st, 2nd and 3rd years of program. community health nursing 
R3T 2N2 assoc. professor and 
acting director 

The C.nad an Nur.. 

.I.n...rv f
M '!;I7 

Memorial University of BN (post-RN) - RN's are granted 15 
Newfoundland non-specified credits on admission. 
Program is 6 to 7 semesters 
St. John's, Nfld. Margaret D. McLean Diploma in Mental Health and psychiatric 
A 1 C 5S7 director 
School of Nursing nursing 
-2 semesters plus clinical experience 
Diploma in community health nursing 
-2 semesters plus clinical experience 
Degree and/or diploma program in 
Midwifery and Outpost Nursing 
-8 semesters or 3 years, 5 semesters or 
2 years, respectively 
New Brunswick, University of BN-3 years (RN's join basic students 
after 1 st year) 
Fredericton, N.B. Irène Leckie -part-time study available. 
E3B 5A3 
Ottawa, University of BScN-3 years. *courses have changed, M.H.A. - Health administration 
check 80-81 calendar . 2 years 
Ottawa, Ontario Marie des Anges Loyer -may be taken part-time; courses must 
K1N 6N5 director be completed within 8 years of start 
Faculty of Health Sciences 
Deadline for application 
June 1 
Queen's University BScN-Basic program is 4 years; RN's 
may receive some credit for 1 st and 2nd 
Kingston, Ontario Alice J. Baumgart year courses 
K7L 3N6 
St. Francis Xavier University BScN-3years 
Antigonish, N.S. Ellen Murphy 
B2G 1 CO chairman 
Dept. of Nursing 
Saskatchewan, University of BSN-15 credits, 3 years (up to 9 courses Diploma in continuing 
available through University of Regina) education -1 year 
Saskatoon, Sask. Hester J. Kernen 
S7N OWO -up to 2/3 of the program may be taken M.C.Ed. -1 year plus thesis 
in Regina through University of Regina 
M.Ed. in continuing education 
-1 year plus thesis, Or 2 full 
Toronto, University of BScN-3 years MScN -2 years, focus on 
first and second years are available on a clinical specialization and 
50 St. George St. Phyllis Jones part-time basis through Woodsworth research 
Toronto, Ontario College to graduates of diploma nursing 
M5S 1A1 school only 
Victoria, University of BSN-2 years full-time, or up to 6 years 
part-time (with at least one full-time year) 
P.O. Box 1700 Dorothy J. Kergin, PhD 
Victoria, B.C. Associate dean 
V8W 2Y2 Health Sciences 
Deadline for application 

38 Jenuery 188û 

The C.n8d1en t!ui3e 

Western Ontario, University of BScN-3 years (may be taken part-time) MScN (administration) 1 
calendar year 
London, Ontario Beverlee Cox PhD 
N6A 5C1 MScN (education) 1 calendar 
on year 
May 7st 
Windsor, University of BScN-3 years 
Windsor, Ontario Anna Temple Diploma in public health nursing-1 
N9B 3P4 academic year may be done part-time, 
finish within f {ears of start 
Laval, Université B.Sc.lnf-3 ans 
Cité universitaire Thérèse Fortier 
Ouébec, P.O. G1K 7P4 
Moncton, Université de B.Se.!nf 
Le programme d'intégration pour les 
Moncton, N.B. Marcelle Dumont infirmières autorisées peut se faire à plein 
E1A 3E9 temps-<:leux ans-ou à temps partiel. 
Montréal, Université de BoSe. d-3 ans 
Case postale 6128 Diane Goyette 
Succursale 'H' 
Montreal. P.O. H3C 3J7 
Ouébec, Université du 
Trois Rivières. P.O. Louise Migneron BScN-3 ans 
G9A 5H7 
Chicoutimi, P.O. Brenda Dutil BScN-3 ans 
G7H 2B1 
300 Ave des U rsulines Denis Rajotte BScN-temps partiel 
Rimouski, P.O. G5L3A 1 
Case postale 1250 Fernande Viens B.Sc.lnf-plein temps ou temps partiel 
Succursale 'B' 
Hull, P.O. J8X 3X7 
Sherbrooke. Université de BScN-90 crédits 
Centre Hospitalier Universitaire Denise Lalancette 
Sherbrooke, P.O. 
J1 K 5N4 
.voir auss; Laurentian University, 

The C.neo.an Nu,.. 

J.nu.rv 1980 39 



an essay on motivation 

Brian Cristall 

"And when you have determined what Is to be done under the 
circumstances. still you will usually have no power to compel the 
necessary course of conduct. except through those motives to 
action which are consonant with the hopes. the fears. the 
prejudices of your patient... you must be able to judge quickly as 
to these motives. This judgment can only be founded on a 
thorough knowledge of human nature, and this knowledge and 
the use of It, therefore, constitute Important elements of 
professional skill and tact. .. 

- Thomas Laycock (1812-1876) 

40 January 1980 

The Canedlan Nuree 

Recently, I was asked by the supervisor 
of the public health nurses in my 
community to give a lecture on 
motivation. I was very reluctant to do so 
because moti vation is such a large and 
general topic, but she explained to me 
that what the PHN's were interested in 
was the question of how to motivate their 
patients. I began to search for an answer, 
but after a short while came to the 
frightening conclusion thatl didn't have 
any answers to this question and 
therefore couldn't possibly give the 
nurses a lecture. I told this to the 
"That's good," she said, and went 
on to say that she expected my 
presentation in two weeks. 
Perhaps that's an important way of 
motivating people, I thought: don't let 
them think about what you're asking, 
just tell them to do it and perhaps they 
will. But there had to be more to it than 
that. What she did that was even more 
powerful as a motivating force was to let 
me know she believed I could give such a 
lecture, when I had been wallowing in 
uncertainty. I went on to prepare the 
lecture because I felt better having her 
confidence in me. People have to belie
they can do what is asked of them. 
Obviously, there is a great deal to 
motivating people, more than the two 
suggestions I have made, and neither of 
these is very helpful to the nurse who 
wants an answer to the question, "How 
can I best motivate someone?" 
One can easily understand the 
nurse's preoccupation with motivation 
and the facilitation of change. Nurses are 
constantly looking for solutions to the 
problems people present in their work. 
It is important though for anyone 
involved in helping other people to 
acknowledge just how dependent any 
therapist is on being able to come up with 
solutions; a lot of anyone's self-worth is 
tied up in being able to do something 
concrete to help. Problems without 
solutions tend to make a person feel 
A tentative answer then to the 
question, how can I help, might be 
simply 'listen to your patient' . And by 
this I mean really listen, and hear what 
the person is saying to you. Listen to the 
problems that are very real to that 
individual, to the sadness and 
helplessness they feel. But remember- 
it is not your responsibility to decide 
what that person should do. or where he 
should go. 

Once you understand this, you have 
grasped the fundamental truth, that you 
cannot in faCI motivale anybody to do 
anything, you can only allow them to 
motivate themselves. 
You ha ve no power to 'cure' anyone 
of his problems, and indeed it is an 
interesting paradox that when you try to 
motivate someone to change. you end up 
actually interfering with his natural 
motivating forces. If you stan believing, 
as a patient or his family might. that you 
have the power to motivate or to change 
them, then you are getting trapped by the 
people you are working with. 
Understand for instance the message you 
might get from a distraught mother: "My 
world is broken and only you can fix it." 
Not true. Only the mother can fix it, only 
the mother has the motive power to 
repair her own life. 
Listening to people will provide }- ou 
with clues as to what is wrong with their 
own stTength of will: you will hear in 
their stories about the conflict and fear of 
change: ". can't do that. I've never done 
that." Active listening is the key to basic 
contact with another person, and honest 
and genuine response is another. 
There is no one response that will fit 
every patient: one must respond 
differently to different people, and even 
at different times with the same person. 
There is no right or wrong response 
either, there is only a response that is the 
result of sensitive listening. Ifsomeone's 
problem is such that you can't offer any 
help, say that, share that fact with the 
person. It may be a relief for him to hear 
that a professional doesn't know what to 
do either. 
Any individual in a helping 
profession has a most difficult ta<;k. We 
must work with multi-problem situations 
and families where the very real 
economic and social realities are such 
that the problems are probably 
impossible to solve. Ifa 
fourteen-year-old native girl's father ran 
away with another woman, and her 
mother was a drunk; if men take 
advantage of her sexually and beat her to 
relieve frustrations, then we have a very 
real problem but one that's impossible to 
solve. There's nothing that you can do to 
change the economic and social realities. 
But you can make the kind of basic 
contact with the native girl which will 
allow that girl to explore her life's story, 
and come to accept the fact that life dealt 
her a bad hand; that's rough, but that's 
it. Only by establishing the kind of 
human contact in which the girl Can 
safely explore her feelings toward her 
horror story. will she ever be able to 
begin to make the kind of changes 
necessary for her to find fulfillment in 

But the motive power for change 
and for working against these very bad 
odd<; must come from within that girl and 
can never come from the outside. 
What I have been saying then is not 
that Ihere are ways to motivate people, 
but that there are ways for a profes<;ional 
person to help people motivate 
themselves. In relating to a patient you 
do one of three things: you either 
motivate them, do absolutely nothing for 
them, or you actually block their 
motivation. To understand this, it is 
helpful for nurses to know what kind of 
things contribute to health care workers' 
blocking patients' motivation. 
. Values. Many professionals find the 
personal values of the people they work 
with vary greatly from their own. An 
example: you enter a house for the first 
time and you find a filthy mess. The 
dishes are dirty, clothes are scattered 
everywhere, and the baby's diapers are 
full. You think: this house is a mess, how 
do. motivate this woman to get this 
place cleaned up? But the dirty house 
isn't her problem, it'syour problem. 
. Culture. Nurses and other 
professional workers come most often 
from middle class backgrounds and are 
unable to understand the characteristics 
and pressures existing in other social 
· Sellsiti,'ity. Unlike psychotherapists 
in private practice, health care workers 
cannot choose the people they work 
with, and they cannot be sensitive to all 
the people they come in contact with. 
· Expert whiplash. Many ofone"s 
clients or palients will have had 
numerous experiences with expens or 
professionals and may have had bad 
experiences. making them less 
· The "I'll help you" hang-up. Many 
workers unconsciously display an 
attitude that says let me rescue you, 
which is in essence a top dog-underdog 
situation, with the professional having 
the upper hando In this situation, the 
underdog may win by not being helped. 
All of these are important factors to 
remember, as is the idea mentioned 
before that health care workers often 
have a great deal of their own personality 
invested in coming up with a solution for 
people. If you find yourselfgiving lots of 
advice instead of really listening and 
responding genuinely, it's a certainty the 
patient's motivation is being blocked. 
Back at the beginning of this article I 
said that nurses usually want to know, 
"How can I motivate someone?" And 
my answer to that is, you can't. The 
question is all wrong; when you ask 'how 
can 1...' you are taking responsibility for 
your patient, and that's the first wrong 

The Canadian Nur.. 

Well, you ask, how can a nurse be of 
any use? How can a nUl se in hospital 
motivate the patient with an ileostomy to 
learn how to use his appliance himself? 
How can the community health nurse 
whose diabetic patient is still dependent 
on her persuade that patient to give his 
own injections? What to do? 
The nurse can be helpful in many 
ways, not the least of which isjust being 
there. You are another human being 
capable of the same emotions and 
subject to the same stresses as your 
patient. You can provide the acceptance 
and support that nurtures motivation and 
personal growth, and you can listen 
actively and with purpose. 
While it would seem there isn't any 
magic answer to the problem, there is 
one word that describes the nurse's role 
here: that word is "Caring" 0 Knowledge 
and technical skills are all very well, but 
without real personal caring there is no 
power in Ihem. As long as one chooses 
always those actions which reflect 
caring. one cannot go wrong. 
As Don Juan tells Carlos in 'J ourney 
to Ixtlan', "All paths lead to the same 
place, and that's nowhere, so always 
follow the path with a hean. .. 

Brian Cristall,B.A., M.Ed., is a 
psychology instructor at Northern Lights 
ColleRe in Dawson Creek, B.C. He is 
a/so a counsellor for both students and 
members of the community. 

I Bugental. James F. Psychotherapy 
and process: the fimdamentals of an 
existential-humanistic approach. 
Reading, Mass., Addison-Wesley, 1978. 
2 Dass. Ram. Gristfor the Mill. 
SantaCruz. Ca.. Unity Press, 1977. 
3 Egan, Gerard. The Skilled Helper: 
a model for systematic helping and 
interpersonal relating. Monterey, Ca., 
Brooks/Cole, 1975. 
4 Kopp, Sheldon B. Back to One: a 
practical guide for Psychotherapists. 
Palo Alto, Ca., Science and Behavior 
Books, 1977. 
5 Kopp. Sheldon B. Guru: 
Metaphorsfrom a psychotherapist. Palo 
Alto, Ca., Science and Behavior Books, 
6 Kopp, Sheldon B./f you meet the 
Buddha on the road, kill him! The 
Pilgrimage of Psychotherapy patients. 
Palo Alto, Ca., Science and Behavior 
Books, 1972. 

Janu..... 1980 41 

Mohamed H. Rajabally 

This year, after almost a decade of 
co-operative planning and 
preparation, the Canadian Nurses 
Association (CNA) will introduce its 
new comprehensive examination for 
nurse registration. (S ee The 
Canadian Nurse, May, 1979). As a 
result of this commendable 
achievement, Canada will become the 
first nation in the world to implement 
a nursing examination of this nature 
for persons wishing to enter the 
profession. Obviously, the leaders of 
Canadian nurr,es know something 
that their American counterparts do 

Underlying introduction of the 
comprehensive examination is the 
rationale that change in our present 
system of examinations is necessary in 
order to keep pace with the changes that 
are taking place in nursing education. 
These changes have occurred because of 
the movement in recent years towards 
integrating nursing programs and the 
preparation of general practitioners at 
the basic level. The comprehensive 
examination wilI permit the national 
Testing Service for beginning 
practitioners to reflect these changes and 
to test more realisticalIy the applicant's 
ability to solve the nursing care problems 
typically found in nursing practice. 
Under the new system, aspiring 
candidates who fail any part of the 
comprehensive examination will have to 
rewrite the entire exam. Compared to the 
soon-to-be-deposed five-part 
examinations which alIow students to 
rewrite only the subject(s) in which they 
fail to obtain a passing mark, this 
undoubtedly imposes a new degree of 
difficulty on prospective members of the 
profession. The director of the CNA 
Testing Service, Eric Parrott, comments: 
"The 'old' registration examinations 
were based on a medical rather than a 
nursing model." I That same medical 
model has been under constant attack by 
nurse educators and has divided nurses 
into opposite camps of incompatible 
loyalty to the old and so called 'new' 

42 Januery 1980 

CNA contends that the nev. 
comprehensive examination wilI test the 
candidate's cognitive abilities by 
requiring the writer to demonstrate the 
integration of the elements of knowledge 
basic to a discipline in solving problems 
presented in a series of situations." Many 
educators wilI confirm, with some degree 
of justification, that up to now there have 
been no examinations which realIy 
separate the competent from the 
incompetent with any degree of 
accuracy. Also, in assessing through 
examinations whether or not a person 
wilI make a good nurse we are looking at 
probabilities, not certainties. 
What magic spelI has the word 
'integration' cast over the nursing 
profession in Canada that would 
influence it to invest 10 years and untold 
sums of money on the development of an 
examination to accommodate the 
concept of integration? Within the 
framework of nursing curriculum, the 
word 'integration' implies blending the 
nursing content in such a way that the 
parts of specialties are no longer 
distinguishable. This involves 
concentrating on the generalizations 
relating to nursing rather than specifics. 3 
It is obvious that the 'old' examination 
for registration does not meet this 
criterion. Is this a handicap of such 
magnitude that it has to be eradicated as 
a pest? Or is it a reality compatible with 
today's practice of nursing? 

The Canadian Nur.. 

While the CNA Te<;ting Service i
forging full speed ahead on the 
integration bandwagon. the trend in the 
United Slates. where the concept of 
integration was conceived and born and 
where we got our ideas from in the first 
place. is reversing itself. A few school<; 
of nursing have already jumped the 
integralion track and are headed off in 
other directions. As more faculties feel 
comfortable and secure in openly 
conceding the limitations of the 
integration syndrome, new avenues will 
be explored and new compromises 
made. 'The school of nursing at the 
University of Kansas. for one. has opted 
for compromise between integrated and 
logistic tactics. which is a 
disease-centered or body systems 
approach to teaching. Had nurse 
educators been realistic earlier. perhaps 
we would not have been swayed by the 
magic word, 'integration'. 
I am convinced that if we look 
closel y. we will find that the wheel has 
turned full circle and if, in turning with it, 
we have learned anything at all, we must 
change our behavior to accommodate 
this newly acquired knowledge. It is 
about time that as educators we put our 
act together so that we can command the 
respect of practicing nurses.'" 
I CNA Testing Service. 
Canad.Nllrse 75:5:44-45. May 1979. 
2 Ibid. 
3 Torres, Gertrude. Educational 
trends and the integrated curriculum 
approach in nursing. (In National League 
for Nursing. Dept. of Baccalaureate and 
Higher Degree Programs. Faculty 
curriculum development. Pt.4. Unifying 
the curriculum - the integrated 
approach. New York. c1974.) P02. 
4 Styles. Margretta M. In the name 
of integration. N IIrs .olltlool.. 
24: 12:738-744. Dec. 1976. 
5 Veith. Shirley. Rethinking the 
integrated curriculum. N IIrs .Olltlook 
26:3:187-190, Mar. 1978. 
About the author: Jlohamed Ho 
Rajabally is probabl\' best I..nown to CN) 
readers as the author of "N ursing 
Education: Another Tower of Babel?" 
which appeared in the September 1977 
isslle of this journal. He is a lectllrer in 
the F acuity of Nursing at Okanagan 
College in Kelowna, RoC. and is also a 
PhD student in the College of Education 
at Washington State Unh'ersity, 
Pullman, Wa. 

CNA's Director of Testing Service Responds: 


I have difficulty tleciding what message the author IS tning to 
convey about integration. examination.. and nur
ing educltion 
b he recommending that examinations. ..hould be aboli<;hed. or 
que<;tioning whether we have yet found the right techniques t(I 
develop examinations that will separate competent from 
incompetent nurse
 with accuraq ? Does he believe the 
registration examination should me ure 
pecialitie", or that 
integrating content on! 
 allows the testing of generalizatIons 
it his contention that nursing cannot <;upport the "promotion of 
health" and . 'treatment of disease" at the "ame time. and 
because so much oftoday's health care is related to curing 
disease, that we should not strive for change in trving to 
promote healthier lifestyles'
Does he believe that two-year 
diploma programs are educationally unsound and that somehow 
this is related to the integration of nursing content. or to the fact 
that nurse educators implemented such programs against the 
better judgment of experienced practitioners? 
While I can understand that the expectations nurse 
educators and nUf<;e practitioners have of new graduates ma} 
not be congruent (though I hope their broad goals or objective.. - 
are), to suggest that educators should "push for integrated 
wards or units to accommodate... (the) products of 
integration"leaves me puzzled. I hope that a nurse "ho ha
been educated in an "integrated" program would make positive 
transfers of learning and perform competently in a variety of 
settings (medical. obstetnc, and so on). once any additional 
preparation needed to work in a particular setting has been 
acquired. Although It might be useful for hospitals and 
educational programs to have the same organizational structure 
(either integrated or di\ided into clinical areas). I don't see that 
it is essential. It seems to me that the aim of many integrated 
programs to place nursing in a problem-sohing context so that 
knowledge and nursing care are not fragmented is most 
appropriate. and just as relevant in practice on a psychIatric unit 
as on a surgical unit. 
As for the statement that "we get our idea" in the firsl 
place" from the United States. I have a lot of affection and 
respect for my American friend.. and colleagues. but I don't 
think a Canadian idea has eighty-five cents worth of ment while 
an American idea is worth one dollar. Nor do I think that 
Canadian nurses are unable to generate ne't' approaches to 
nursing education and practice. I hope that the American 
schools which have "jumped off the integration track" are not 
like the horseman who rode off in all directions at once. I 
suspect that no school of nursing. American or Canadian, has 
discovered the "ideal" curriculum. Therefore. to find that an 
integrated program has some limitations is not surprising. My 
hope is that nursing educators will design curricula to reflect 
their own individual beliefs and needs '" not jump on the 
"integration bandwagon" just because the CN A Testing 
Service is integrating examination content, or because it seems 
to be the popular thing to do. A variety of educational 
approaches might be more interesting than trying to fit all 
programs into the same mold. Whatever approach a school of 
nursing uses. I earnestly hope the nurses graduating from it are 
.. integrated". If not. who will put Humpty Dumpty together 
I predict that well-prepared candidates. whether from an 
integrated program or not, will be able to pass the 
comprehensive examination. The key concept is competency in 
nursing - not integration 


Eric G. Parrott 
Director ofT esting Service 


The Canad'811 Nurse 

Jan ary, 980 43 


The Experience of Two Nursing Schools 

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Jeannette Bouchard. Marilyn Steels 



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 71 L ' 


The nurse as a change agent! Coping 
with change! Can nursing educators 
afford to take the risks involved in 
inviting students to participate in the 
selection of their own learning 
Preparation of the student for 
on-going learning is a major 
responsibility of the educational 
system in our rapidly changing world. 
Given the short half-life of 
professional knowledge in the health 
field, it seems imperative that nursing 
educators no longer strive to provide 
a finite package of knowledge. 
Opportunities to be self-directed 
within the security of an academic 
milieu should facilitate the 
development of skills needed to 
assume responsibility for change. 
Self-directed learning has been 
promoted in two nursing science 
programs in Ontario through the use 
of contracts, Two nursing educators 
share their experiences using contract 
learning in year two of the four year 
program at McMaster University 
(1976-7) and year four ofthe nursing 
program at Laurentian University 

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44 January 1980 

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UA learning contract is a document 
drawn up by a student and his instructor 
or advisor which specifies what Ihe 
student will learn, how this will be 
accomplished and within what period of 
time, and what the criteria for evaluation 
will be.'" Contract learning,like 
independent study, places more 




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Th. Canadian Nur.e 

responsibility on the learner for planning 
his own work and pursuing his own 
objectives, while the instructor remains 
responsible for developing a broad 
framework of course objectives and 
expectations within which each student 
develops his specific contract. The detail 
and scope of this necessary framework 
varies according to the experience and 
developmental level of the learner. 
Without such a framework, the student 
may experience anxiety when making 
basic decisions which should be th\: 
responsibility of the educational system 

.;.-. . 
. ,



A learning contract has many 
positive attributes; it 
. suppons the leamer's self-concept 
as an autonomous adult with a 
background of personal expenence and 
expectations for the future which help 
him identify personal learning needs. 
. permit
 the identification and 
confrontation of real and relevant 
problems rather than confinement within 
a prescribed subject-centered learning 
. promotes a sense of personal 
responsibility for learning. 
. permits more relevant and 
meaningful learning experiences. 
. allows the instructor, being freed 
from the constant strain of content 
transmission. to focus on the individual 
student and his progress. 
. promotes competition with self to 
meet self-formulated standards rather 
than competing with peers. 
. provides a vehicle for 
communication between student and 
. assures on-going personalized 
feedback between student and teacher. 
. provides a clear record of the 
student's personal learning process. 
· promotes expression of creativity 
by inviting and encouraging students to 
take risks in designing their learning 
experience within the boundaries of the 
course objectives. 
However. effective contracting 
requires several essential basic 
conditions, such as compatibility with 
the school's philosophy: commitment 
and security on the pan of the 
instructors: a clear set of general course 
objectives: an acceptable and 
well-delineated set of requirements and 
expectations and an explicit procedure 
for contract development: intensive 
facilitative interaction between student 
and instructor: formative rather than 
punitive evaluations: peer suppon within 
both student and teacher groups: and 
effective public relations with resource 
individuals and agencies. 

The authors' experiences 
The contract learning process was 
applied in two nursing courses which 
combined theory and praclice. The year 
two course focused on human growth 
and development throughout the lifespan 
with the students working with well 
children and families at varying stages in 
the maternity cycle in one term and with 
individuals and families experiencing 
situational crises related to surgery in the 
second. Core plans brought students 
from both rotations together to discuss 
broad concepts relevant to all areas of 
nursing. The year four course, taken in 
one term, focused on the analysis of 
individual practice by selecting and 

exploring in depth one theory of nursing 
and applying it clinically with several 
patients and families. A research study, 
used as a theoretical base, was carried 
out and small group seminars considered 
the applicalion of the theory clinically 
and implications of the research. 
Initially, terminal objectives were 
presented and discussed. In a group 
setting. the students were asked to 
identify factors which helped and 
hindered their learning: using this input, 
beliefs about the adult learner and 
,>elf-directed learning were identified. 
This paved the way for the introduction 
of contract learning. In both instances, a 
class wa
 devoted to the purpose of this 
tool and details of its implementation. 
Handouls were given explaining 
expectalions and clarifying the steps of 
contract development. These guidelines 
included examples of appropriate 
learning activities. suggestions for 
suitable types of evidence of learning in 
each domain and suggestions for the 
development of criteria and means for 
validating this evidence. As well, options 
were described for students who failed to 
meet their contracts. 
Although the process remained 
similar in both courses, it was in the 
application of the specific ex pectations 
that differences occurred. The "givens" 
fell into five categories: final dates for 
contract negotiation and submission of 
evidence, content, requirements for 
specific types of evidence, a requirement 
for a grade "C" contract, and provision 
for work in groups. In both groups, 
contracts were to be finalized three 
weeks before the end of the term with a 
final date for submission of evidence also 
specified to allow faculty time to 
complete an evaluation. The content 
givens guided the students to develop 
objectives and select learning 
experiences relevant to the course. 
In year Iwo, we intended that the 
- focus on health. not pathology 
- relate to an age group within the scope 
of the student's current clinical rotation 
- show the application of one ofthe 
core concepts under study in c1a<;s that 
- and show the relationship of the 
planned learning activities to the 
conceptual framework of the course. 
I n year four, the contract was to: 
- develop a personal framework of 
nursing practice 
- reflect an analytical approach to the 
process of nursing care 
- and utilize a selected concept in the 
scientific investigation of a nursing 

The Canadian NUrM 

In year two, a formal essay was 
required as panial evidence of contract 
fulfillment and in year four. a formal 
research paper was to be completedo 
The grade C contract requirement 
was included to ensure that students who 
overextended themselves would have a 
more easily attainable contract to fall 
back on. However, a grade A or B 
contract could be negotiated based on 
changes in or additions to objectives, 
learning activities, as well as evidence 
and/or criteria for evaluation. 
Crileria for group projects were 
established to assure each group member 
ofa personal evaluation. Each student 
was expected to develop his own 
contract and was held accountable for 
producing evidence congruent wilh his 
objectives and negoliated grade. 

.acult) strategies to facilitate the process 
of contracting 
Cenain provisions were made in advance 
to assure thai the experience of 
contracting proceeded as smoothly as 
possible for both students and faculty. 
Regular appointment schedules were 
established with a sp<:cific weekly time 
assigned for second year students to 
meet with their instructor, while founh 
year students were expected to set up 
their own appointments as they deemed 
necessary. An average of 20 to 30 
minutes were spent weekly with each 
student discussing matters related to the 
contract: this time investment was 
necessary for both groups. 
Provisions were made for mediation 
of contract disputes in both cases. In 
year two, time was spent in team 
meetings almost every week discussing 
contracts, with student representatives 
involved in much of the discussion. In 
addition, a special time was set asidejust 
before the date for contract finalization 
to resolve any impa<;ses. The fourth year 
students were informed that if an 
impasse in contracting occurred, another 
fourth year faculty member would be 
invited to serve as mediator. 
Class size and attendant faculty 
numbers did not constitute a problem at 
Laurentian University. At McMaster 
University, however, a m
for students and faculty alike was the 
issue of achieving fairness when six 
faculty were involved in setting 70 or 
more learning contracts. When the 
diversity of projects is such that 
equivalence of work is difficult to assess, 
students become competitive with each 
other and faculty are forced into the 
difficult task of trying to be consistent 
not only with each other but with 
themselves. Time spent in team 
meetings, as well as one to one 
discussions amongst faculty, were used 
to ensure consistency. 

January 1980 4'" 

To a void fru
trating and 
non-productive delays in the studenl 
learning process, students were 
encouraged to begin to pur;ue their 
learning activities before their contracts 
were finalized. Their learning 
expenences dunng this period of 
contract evolution lessened their 
 and helped them clarify their 

pecific areas of interest and learning 

Although anything that was legal, 
ethical and fea'iible within the contract 
requirement'> wa
 encouraged. some 
guidance was provided to year Iwo 
students in relation to appropriate topics 
and learning resources. This guidance 
was provided through set
thought-provoking que
tions. lists of 
faculty and community expertise. and 
packages containing written resources in 

a variety of areas. Students were 
encouraged to add to these packages and 
to u
e a 
pecial bulletin board that was 
set up for conveying information relating 
to various learning experiences. In both 
situations. letters of introduction were 
prepared on school of nursing letterhead 
for students wi
hing to establish contact 
with persons not previously solicited by 
the school. For the fourth year students. 
resources were provided but not 
calegorized under specific topics per se; 

LEARNING CONTRACT FOR COURSE: Student: Jane Myles Instructor: Marilyn Steels 
NSG 2004 Date Evidence Will Be Submitted: April 16, 
Learning Objectives (include Learning Resources and Evidence of Accomplishment of Criteria and Means for 
relationship to course Strategies Objectives Validating Evidence 
1. To discover what community Interview Board of Directors of Bib. card: listing and describing Name of resource person. 
resources are available for Ostomy Association. Interview community resources available to Description of community service, 
colostomy patients. ostomy nurse. ostomy patients. location, function for ostomy 
patients, group activities. 
2. To identify resource personnel, Arrange with ostomy nurse to Presentation by ostomy nurse Tutorial leader comes to 
their contributions to patient care. come and speak to a group of takes place on March 25. presentation. 
To share this knowledge with nursing students and other heanh Evaluate whether knowledge has Questionnaire: general questions 
peers and other heanh team team members. been passed on to peers through conceming knowledge gained 
members. a questionnaire given after the from the presentation. 
presentation. Chart representation of response. 
Summarize in chart form the 
response to the questionnaire. 
3. To leam to conduct an Interview an ostomy patient Written evaluation of interviewing Criteria for good interviewing 
information gathering interview concerning any skills. skills. 
with resource personnel. physical/psychological adaptlon Analyze adaptive process. Introduction of self and topic of 
problems encountered after the Consider the effects of the study. 
operation. colostomy on the developmental Open-ended questions. 
tasks of the adult interviewed. Summarized interview and 
concluded interaction. 
Evaluation of interview. 
Stages of adaption patient went 
through; difficulties; present 
1 Same as 3. (above) Same as above Same as above As above item plus refrain from 
giving advlcelbeing judgmental. 
Identifying and validating verbal 
and nonverbal cues. Utilizing this 
data, maintain the interview. 
Evaluation of interview. 
Stages of adaption. 
2. To plan and implement a Poster Discussion following presentation Presence of tutorial leader to 
teaching approach for peers so of poster, focusing on anecdotes make sure psychological adaption 
that they gain a basic in which there were and growth and development are 
understanding of the manifestations of the included in presentation. Clarify at 
psychological stages of adaptlon psychological adaption stages. presentation. Helping group to 
which a colostomy patlSnt Include the effects of the problem solve through anecdotes. 
progresses through. colostomy on the growth and Response of group to discussion 
development of the adult. of anecdotes. Ability of group to 
Presentation on Tuesday, April 5. identify stages of adaption as 
presented in anecdotes: will either 
teach or help in problem solving. 
A. Contract successfully negotiated Mar.25, 1979 Student: Jane Myles 
for a B grade. Instructor: Marilyn Steels 
B. Contract successfully met for a April 16. 1979. Student: Jane Myles 
B grade. Instructor: Marilyn Steels 

48 Januery 1980 

The Canadian Nur.. 

it was left lO the student's initiative to 

eek out peninent re
ources as well as 
leuers of introduction. 
Guidelines "ere provided for 
 in both seuing
 in relation to 
expectations for the fulfillment of grade 
A. Band C contract
. It "a
 hoped Ihat 
students would grasp the idea Ihat 
quality of work was at least as important 
as quantity. E...ampleo; were given 
sho" ing how different words and 
phrases used to describe learner 
behaviors can reflect the quality and 
complexity of the learning process. Also 
suggestions were given describing types 
of evaluation tools available for specific 
types of evidence. The use of external 
appraisers for evaluation of evidence 
was encouraged. By including the name 
of the proposed evaluator and his/her 
qualifications in the contract, the idea 
was reinforced that the teacher was not 
necessarily the best qualified person to 
evaluate the student in all areas, but 
remained the person responsible for the 
overall evaluation of student 

aluation of the experience 
The gains from contracting exceeded the 
investment oftime and effon by all 
panies involved. Released from the 
restraints of traditional course 
requirements. students and faculty freely 
expressed Iheir creativity 0 Although 
initially students were hesitant and 
insecure in making their own decisions 
about learning. contracting provided an 
outlet for creative drives. Students who 
had previously viewed themselves as 
creative, were almost immediately 
enthusiastic. while others discovered 
within themselves their potential for 
innovation. In this latter group, an 
almost metamorphic change wao; noted 
when self-pacing was allowed. An 
inevitable effect on faculty was a feeling 
of excitement and pride. A by-product of 
the wide range of activities generated by 
this atmosphere was the increased 
visibility of both schools wilhin their 
respective communities. 
The time required to work with 
individual students in contract 
development, while necessary. proved to 
be a continuous drain on faculty time and 
energy. At certain peak periods, such as 
just before contract signing, this demand 
became a source of frustration, 
especially for those faculty with less 
flexible schedules. with the result that 
time spent discussing contracts in team 
meetings frequently took precedence 
over other pressing business. 
In neither case did contract disputes 
occur in the true labor relations sense. 

Because of the large number of o;tudents 
and faculty involved in the r-.kMaSler 
c...perience. however, some degree of 
inconsistency was inevitable. Although 
some students did question the degree of 
fairness. generally concerns were 
resolved through discussiono; in leam 
meetings and consultation with faculty. 
I nformal consultations were more 
effertive than the formal mechanio;m set 
up for resolving impa'ises. 
t students began to implement 
their learning plan early in the tenn. and 
as anlicipated, the process of contracting 
helped them focus their energies as the 
term progressed. As with all 
assignments, there were some students 
who were slow starters, resulting in 
stress for both students and faculty. 
The mechanisms set up to assist 
students in securing learning resources 
varied in their effectiveness. In year two, 
the packages oflearning resources 
proved useful, but the response of 
students to the suggestion that they add 
resources to these packages was 
somewhat disappointing. As few 
students used the bulletin board to 
inform others of their intent to contact 
community resource people, many 
resource persons were approached 
several times with similar requests. 
These situations were not encountered 
with the founh year students given the 
numbers and variety ofintere
ts and 
endeavors involved. The learning 
resources that were provided, such as 
various research instruments. 
bibliographies specific to cenain 
concepts, lisls of resource persons and 
guidelines for the use of local libraries, 
proved helpful. In both situations, letters 
of introduction were useful in 
establishing student credibility. 
The guidelines describing 
expectations for A, Band C grades were 
essential as this was the fi
t exposure to 
contracting for both groups. As with any 
individual learning experience, however, 
a certain degree of subjecti vity was 
inevitable. Thio; posed a problem, 
panicularly when faculty and students, 
inexperienced with the contracting 
process. set evaluation criteria that were 
so general that the judgment regarding 
their achievement had to be subjective. 
Because contracts were finalized three 
weeks before the end of the tem, an 
unforeseen problem arose. Some 
students submitted evidence which 
exceeded specifications of their contract 
and there was no provision in the process 
for upgrading their mark. This seemed 
unjust. panicularly in view of the 
reasons for contracting and the fact that 
a lower grade could be negotiated if the 
student failed to meet the stated 

The Canadian Nurse 

The requirement that each student 
begin by writing a C contract became a 
cumbersome and redundant exercise for 
students who had their sights clearly 
focused on achieving an A or a B from 
the out
et. Those" ho saw themselves ao; 
C student
 at the beginning would 
probably have chosen to begin with aC 
contract anyway, although they often 
changed their self-expectations ao; Ihe 
term went on. 
In both groups, faculty were 
impreso;ed by the creativity displayed by 
the students. One form this creativity 
took wao; the development of original 
tools for evaluation. The use of external 
dppraisers for evaluation was more 
common in year four than year two but in 
neither case, did students take full 
advantage of the resources available 
outside of the school of nursing, 
probably partially due to a lack of 
previous exposure of service personnel 
to this role. 
More students seemed to opt for 
working in groupo; in year two than in 
year four, which probably was indicative 
of the developmental level of the learners 
and the fact that year four students were 
in individualized clinical placements 
according to their personal interests. 
When students did choose to work in 
groups. it became difficult in both 
situalions to clearly differentiate the 
work of one student from the work of the 
other and fruslrations in contract writing 
and in evaluation of evidence resulted 

Contract learning has now been 
implemented in all four years of the 
nursing science program at McMaster 
University and its use at Laurentian 
University is increasing. For those 
intereo;ted in integrating this type of 
learning experience into their nursing 
program, these are our 
I. As creali vity is inherent to 
contracting. provisions for its expression 
must be provided, as early as possible in 
the experience. However, guidelines are 
essential. with the need for detail and 
specificity varying with the 
developmental level of the learner. 
2. The time commitment necessary in 
contract learning precludes the use of 
this strategy by faculty who function in 
situations demanding a large 
student-teacher ratio. A maximum ratio 
of 12 to one is recommendedo Provision 
must also be made for discussion among 
faculty, with the most effective 
communication frequently taking place 
on a one-to-one level. 

Jenuery 1980 47 

3. A formal mechanism to deal with 
contract disputes, although rarely 
required, will give both students and 
faculty a sense of security. 
4. Initial contracts should be signed 
within the first six weeks of the term to 
help the students pace their learning 
experiences. By incorporating 
provisions for contract negotiations until 
the termination of the course, difficulties 
which arise when evidence submitted 
does not match the specifications of the 
contract are eliminated. 
5. Several mechanisms to assist students 
secure learning resources should be 
provided with a continuing emphasis on 
the responsibilities of faculty and 
students to build shared resources. 
Methods to ensure community resource 
persons are not overloaded with student 
requests should be devised. 
6. Faculty groups must predetermine 
common expectations for quantity and 
quality of work required for the 
fulfillment of A, Band C contracts. 
Students should be permitted to 
negotiate at any contract level, with 
provisions for up or down grading. 
7. As external appraisers are identified 
they must be orienled to their role in 
student evaluation through a basic 
orientation to the philosophy and 
mechanics of contractingo 

Students & Graduates 

8. Resource persons outside ofthe 
school system should be given feedback 
through letters of thanks or copies of 
student work. 
9. Although evaluation of individuals 
working within a group is difficult, group 
work should be supported, perhaps by 
accepting group contracts and giving 
group grades 0 This would place the onus 
on the students to ensure that all 
members of the group contributed 
equally; failure to contribute to the full 
extent, would mean that the individual 
would not benefit from internalizalion of 
the learning experience. The tedious 
process of settling on grades for 
contracts left the authors questioning the 
appropriateness of assigning grades to 
contracts at all. '" 

*Donald. J.G. Contracting for learning. 
LearninRDevelopment, April. 1976. p.2. 

*Unable to verify in CNA Lihrary 



P.O. BOX 634 

To receive a free sample of Our "needs no starch" cloth, 
and more information. please clip this coupon and mail 

Name .................................... 
(block letIerw) 
Address ............................................ 0 . . . . . . 

City ................................... .Postal Code 

Your graduation school .................................... 

48 Januery 1980 



#'" 3" 



Jeannette Bouchard, a Rraduate of St. 
Elizabeth School o.fNursing, Sudbury, 
Ontario, receh'ed her BScN from the 
University of Ottawa and her MScN 
from Boston University School of 
NursinR. She is currently an assistant 
professor with Laurentian University 
School of Nursing , Sudbury, Ontario. 

Marilyn Steels, BScN, a Rraduatefrom 
McMaster Unil'ersity, receil'ed a 
Canadian Nurses Foundation 
Fellowship in /970 to cominue her 

tudiesfora MSN at Case Western 
Reserve Unil'ersitv. Clel'eland, Ohio. 
While teaching, as assistant professor 
with the McMaster School of Nursing. 
she took part in this project on contract 
learninR. Currently, she is senior nurse 
with the Niagara Branch of the Victorian 
Order of Nurses. 

Notice of meeting 
1980 Annual Meeting and Convention 
22-25 June 1980 
Vancouver, British Columbia 
The 1980 annual meeting and convention of the Canadian 
Nurses Association will be held 22-25 June 1980 in the West 
and Center Blocks, Regency Ballroom, of the Hyatt Regency 
Hotel, Vancouver, B.C. 

The opening ceremony will be held Sunday evening, 22 June 
1980, at 20:00, followed by a reception for members and 
students. Sessions (business and program) will begin at 09:00, 
Monday, 23 June 1980, continuing daily and concluding Wed- 
nesday afternoon, 25 June 1980, with the President's Recep- 

Students enrolled in schools of nursing in Canada are invited 
to register to observe the proceedings of this Annual Meeting 
and to participate in the program and social events. 

Tha Canadian Nurse 



A.. ...- 








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The Cenadlan Nurse 

JenUliry 1980 49 

. Burns 

Print!> of the highly regarded 
CBC film "The Other Child" 
are now available for 
borrowing or purcho.1se from 
offices of the National Film 
Board across Canada. The 
16mm color film deals with the 
burn unit at the Izaak Walton 
Killam Hospital in Halifax, 
N oS. and follows the story of 
several burned children from 
admission to surgery and 
discharge. This film, which 
has affected everyone who 
has seen it, is not listed in the 
regular NF B catalogue; for 
information contact the NFB 
office nearest you. 
. Resuscitation 


CPR: to save a life 
Each year in Canada, 
almost a million people suffer 
heart attacks. And in 
thousands of accidents 
involving electrical shock, 
drowning and suffocation, 
people stop breathing. Cardiac 
arrest follows the cessation of 
breathing in a matter of 
minutes. Many people can be 
saved by effective 
In this film, simulated 
rescue scenes demonstrate 
basic emergency techniques to 
be used in the event of cardiac 
arrest. Each step of the 
procedure is simply and 
vividly demonstrated by 
paramedics and reinforced 
with illustrations. Adult and 
pediatric resuscitation 
included. For information 
write: Visual Education 
Centre, 75 Horner A venue, 
Unit One, Toronto. Ontario. 
M8Z 4X50 

50 Januery 1980 


. Lifestyles 

A large number of 
medical visits are 
hypochondriacal in nature. 
Hypochondriacs are people 
who will not get well. They 
have a need to hold onto their 
symptoms. Doctors and 
nurses have a need to cure. 
What develop., is a "tug of 
Thl British Medical 
n'sGoll \ward for 
1978 has been awarded to 
"Hypochondriacs and Health 
Care: A Tug of War" 0 This 
film is about health care 
professionals treating patients 
who have acquired a lifestyle 
of sickness. It was produced 
by Workshop Films in 
cooperation with Dr. Robert 
R. Rynearson, Chairman of 
the Department of Ps ychiatry, 
Scott and White Hospital. 
Temple, Texas. An excellent 
audiovisual aid for all health 
care professionals. 
A 38 minute color 16 mm 
film or videotape, 1978. 
Rental: $40. Sale: $400 (16 
mm), $350 (video). For further 
information write Workshop 
Films, 4 Longfellow Road. 
Cambridge, MA 02138. 

. Choking: to save a life 
A film that clearly 
explains choking rescue 
techniques to apply to others 
and to oneself. Trained 
paramedics demonstrate the 
back blow, the abdominal 
thrust and the finger probe. 
The film also presents ways to 
avoid choking situations. 
For information write: 
Visual Education Centre, 75 
Horner A venue, Unit One, 
Toronto. Ontario. M8Z 4X5. 

. Autism 
Minority of one 
A film that takes a look at 
behavioral modification 
techniques that aim at 
diverting today's autistic 
children away from mental 
institutions and into normal 
adulthood. For information 
write: Visual Education 
Centre, 75 Horner Avenue, 
Unit One, Toronto, Ontario, 
M8Z 4X5. 

. Childbirth 
Pregnancy: Two people 

A 16 mm color film. 35 
minutes in length. A vi.,ual 
record of the pregnancy of 
uanne and Richard Clarke. A 
documentary record of 
conver!>ations. visits with 
friends and families, and of 
the changing feelings of the 
couple towards each other and 
the growing baby. The film 
approaches the Clarkes, the 
institutions and the people the 
pregnancy put them in contact 
with, in an objective way. 
F or information contact: 
Richard and Juanne Clarke, 
Change Productions, 
18Ahrens Street West, 
Kitchener, Ontario, 
N2H 4B7. 

. Childbirth 
A Labor of Love 

A sensitive motion picture 
dealing with family-centered 
childbirth and focusing on the 
impact of pregnancy on an 
entire family. The film covers 
expectant parent classes, 
discussions about pregnancy, 
birth and post-natal situations 
with parents to be, the 
obstetrician, a psychiatrist 
and a registered nurse 
childbirth educator. prenatal 
exercises, animation that 
demonstrates the normal 
mechanisms oflabor and 
delivery. father participation 
in the lahor and delivery 
rooms and more. A 31-minute 
color sound film. 
For further information write: 
M education I nc., 683 Beacon 
Street, Newton Centre, 
Massachusetts, 02159. 

. Patient education 
A new system of patient 
education is being developed 
by Medifacts and the College 
of Family Physicians of 
Canada, based on the 
pal :ent's use of audio 
ca,;settes and illustrated 
, rochures as learning aids. 
This system involves the 
patient, and often members of 
his family as well, listening to 
a cassette dealing with his 
medical problem. 

The Cenedlen Nuree 

Subsequently the patient i
able to discuss his problem 
more intelligently with his 
physician, with greater 
understanding of the need for 
patient compliance. 
Among the cassettes 
produced so far are these titles 
which have a direct 
application to patients or their 
I. Growing Up (Adolescence) 
46 minutes $6.95 
2. Birth Control 
(Contraception) 41 minutes 
3. Drinking and Drugs 
37 minutes $6.95 
4. Talking about Sex 
89 minutes $9.95 

Each cassette presents 
information in lay language in 
the form of dialogue, narrative 
and dramatized vignettes 
which often enable the patient 
to see himself as others see 
Members interested in 
further information on these 
patient cassettes should write 
to Medifacts Ltd., 43 Eccles 
Street, Ottawa, Ont., 
KIR 6S3. 

. Continuing education 

The Renal Series, a functional 
review for nurses, is now 
being offered by the 
University of Kansas Division 
of Continuing Nursing 
Education. The sequence of 
nine modules and 
accompanying slides is 
designed to increase the 
nurse's understanding of renal 
function and to apply this 
understanding to the care of 
patients with kidney 
impairments. It can be used in 
independent study, discussion 
groups, tutorials, or 
traditional classrooms. 
F or further information write: 
Independent Study, 
ContimlÏnR Education, 
University of Kansas, 
Lawrence, Kansas 66045.... 





1 ,.t 


., .. 
'. , 







· Canada's premier university affiliated teaching hospital (1,000 
beds) requires experienced nurses for a variety of clinical areas - 
primarily in intensive care settings 
. In 1979 Toronto General celebrated 150 years of excellence in 
patient care and a history of medical firsts 
. In 1980 Toronto General moves into new, modern facilities and 
we want you there to start our second 150 years 
. The TGH environment provides an opportunity to work in 
any nursing specialty (with the exception of paediatrics) and 
to actively participate in patient education 
. A quality assurance program enables you to plan, implement 
and evaluate the care your patients receive 
. A comprehensive orientation combined with a continuing in, 
service program provides you with what could be your greatest 
professional challenge 
. TGH provides an attractive salary and benefits package 
coupled with the opportunity to work and play in one of North 
America's greatest cities 

If interested please call Toronto General 
Hospital at (416) 595 1 4182 or write "Nurs l 
ing Opportunities", Personnel Department, 
Toronto General Hospital, 101 College Street, 
Toronto, Ontario, Canada, M5G 1L? 


. Patient classification 

In orderto evaluate the PCTC system as 
a feasible mechanism for making rational 
placement decisions, it is proposed that a 
centralized placement service unit (PSU) be 
established for a suitable region of Alberta 
and a demonstration project be carried out. 
An overall summary of the project, findings 
and conclusions and recommendations for 
policy consideration, PSU demonstration 
project and research in general are provided. 

A Research Report on the Development and 
Validation of the PCTC System. Edmonton, 
Alta., 1979 by K.S. Bay et al., University of 

A system of patient classification by types of 
care (the PCTC system) was developed and 
validated to improve decisions for longterm 
care patients and to provide information 
required for planning and resource allocation 

f ) 




''Limit yourself to kitchen knives 
Jòr afew days." 

It's more than good-tasting, it's good medicine. 
Antibacterial, antifungal lozenges 
\GiI Glaxo Laboratories 

D : 
. . 

52 Jenuery 1980 

The Cenadlen Nurae 

. Single pregnancy 

Punishing the Pregnant Innocents. Single 
Pregnancy in St. John's, Newfoundland. St. 
John's, Nfld. 1978. Thesis (M.S.), Memorial 
University of Newfoundland by Laura Hope 

The primary objectives of this study are to 
determine from data obtained from 40 single 
pregnant girls in the city of St. John's 
a)to what extent social and emotional factors 
inhibit a healthy pregnancy outcome; and 
b)whetherthe established and generally 
accepted social norms for sex-related 
behavior are relevant to the attitudes and 
behavior of young people living in St. John's. 
The primary concerns of those 
interviewed were closely related to their 
perceptions of anticipated responses from 
parents, sexual partners and social groups etc. 
Data analysis also served to identify 
significant emotional milestones during an 
illegitimate pregnancy. 
A discussion ofthe role and 
responsibility of a society to prepare its youth 
for future sex relationships and parenthood 
revealed that there were serious discrepancies 
in attitudes and services within the existing 
socialization process. 
The extent to which specific punishments 
are imposed upon pregnant, single girls are 
described in this study. 
Recommendations for changes in social 
attitudes and approaches to the problems 
associated with illegitimate pregnancies in St. 
John's are included. 

. Gerontology 

Health-Related Problems of Elderly People 
Attending Senior Citizen Clubs/Centers. 
Mississauga,Ont. 1979, by Isabel Milton. 

The purpose of this comparative study was to 
investigate the nature, frequency and severity 
of the health-related problems of elderly 
people attending senior citizen c1ubs/centers. 
Data was collected in three senior citizen 
c1ubs/cente[1;; 24 suburban and 36 rural 
subjects completed a questionnaire with the 
investigator present and 25 of the 32 urban 
subjects completed the questionnaire as a 
structured interview guide as they were 
unable to read English. 
Across settings, more than one-third 
reported health problems related to vision, 
medication therapy, indigestion, appropriate 
diet, appetite and blood pressure and 
one-quarter reported health problems related 
to self-esteem and life satisfaction. 
Health professionals were used to cope 
with health-related problems to a much 
greater extent than the social network, with 
the physician being utilized the most 
frequently. The least utilization ofthe nurse 
was reported in the rural setting. 
This study emphasizes the increased 
need of nursing services to the "well-elderly" 
in geographically convenient and established 
settings. ... 

Special techniques in assertiwness 
training for women in the health 
professions by Melodie Chenevert. 
St. Louis, \losby, 1978. 
Approximate price: $9.75 

The author, Melodie Chenevert, 
B.A.. M.S.. formerly an instructor at the 
University of Wisconsin. School of 
Nursing, indicates in the preface that 
within the health care system women 
account for more than eighty percent of 
all health care workers. She suggests that 
women have been the silent majority, 
rarely voicing opinions concerning 
patient care. Women have traditionall} 
been nonassertive and it is now time to 
prepare to challenge the authorities in 
health care to provide a responsive and 
responsible system. 
The chapters of the book have 
unique titles (e.g.. Of Chickens and 
eagles, Chicks and roosters. How to tell 
a turkey to stuff it!), and excellent 
photographs complement the content. 
An annotated bibliography provides 
additional resources for the reader. 
This book provides a perspective on 
the reasons women tend to be 
nonassertive in the health care field. and 
gives numerous examples of situations 
with which every nurse can identify. 
Throughout the book positive 
examples and strategies are provided to 
assist in developing assertiveness. 
Overall, the book provides light 
interesting reading for all women. 
But. I cannot recommend the book 
for educational purposes because while it 
focuses on women's nonassertiveness. it 
does not in turn adequately delineate the 
activities necessary to change this 

Rel'iewed by Janet L. \1oore, Associate 
professor, Faculty of Nursing, 
Unil'ersity of Calgary , CalKary, Alberta. 
Guide to Nursing \lanagement of 
Psychiatric Patients by S. Dreyer, D. 
Bailey and W. Doucet. 2nd ed. 
Toronto,c.V. Mosby Co., 1979. 
ApprOtimate price: $12.00. 

This book is intended primarily for 
undergraduate psychiatric nursing 
students and to be used as a teaching tool 
for nursing instructors. It utilizes a 
workbook fonnat based on clinical cases 
to facilitate the transfer of applied 
theoretical material from an intellectual 
exercise to the actual clinical situatIon. 
The second edition has been 
updated in view of the trend to treat 
patients in their own communities 


instead of in centralized treatment 
centers. the greater awareness of 
potential danger in treatmg individuals 
simply as diagnostic entities, tightened 
criteria for involuntary admissions and a 
greater a"areness oflhe rights of the 
mentally ill. 
The conceptual framework utilized 
for presenting the major psychiatric 
disorders is anxiety and defense 
mechanisms, which is <;ometimes 

inadequate in :eaching schizophrenia and 
affective disorders. 
This guide is recommended for 
students preparing for their exams but 
not alone as a reference as It requires 
prior reading and/or supplemental texts. 

Rel'iewed by Marilyn Robbins, 
educational cOllsultant. H ami/toil 
Psychiatric Hospital, Hamiltoll, 

Can you name 
the i.v. fat emulsion 
you are using? 
NUTRALlPID.! is the new name for the I.V. fat emulsion 
that you have known and trusted for years. From now on, 
' , but your patient will be getting 
the only fat emulsion that has been safely used for more than 
15 million patients world-wide. 
Only the name has changed. 
The name to remember 
for Lv. fat emulsion. 



,. , I 




o Pharmacia 
Phannacia (Canada) Ltd. 
Dorval. Quebec 

The Cenedien Nur.. 



Jenuery 1980 53 

Teaching clinical nursing ed. by 
S.M. Hinchliff. New York. 
Churchill-Livingstone. 1979. 
Approximate price: $/5.00 

This British paperback attempts to 
give practical help to the nurse teacher in 
both the clinical area and community 0 
Basic information and guidelines on 
many aspects of teaching are discussed 
by various contributors, making the 
book useful for a new teacher. 
Hinchliff initially discusses "the 
process of clinical nursing" in which 

Ovol Drops 
infant colic. 



excellent guidelines are given for 
obtaining a very thorough nursing 
assessment and a clear. comprehensive 
outline of all phases of the nursing 
Despite differences in nursing 
education between Britain and Canada. 
many problems encountered on the ward 
are ofa similar nature and useful 
information is given for planning a 
teaching program on the unit. 
One main theme throughout i., the 
emphasis on the need for good 
communication between the ward staff 




Ovol Drops contain simethicone, 
an effective, gentle antiflatulent 
that goes to work fast to relieve 
the pain, bloating and discomfort 
of infant colic. Gentle pepper- 
mint flavoured Ovol Drops. 
So mother and baby can get 
a little rest. 

0v0I rncP3 


fs . acting 
I :: ant 

ohc I 
Shhh. Ovol Drops. AlooBVBilBbleonLilbletfonnforedulu 

8 H Q ßnE R 

.. Jenuery 1980 

The Cenadlen Nur.. 

and the students and teacher. Another is 
that of student anxiety in the clinical 
setting which can adversely affect 
student growth. independence and 
performance and which all too often may 
be overlooked by an experienced ward 
staff or teacher. 
There is some repetition of 
educational theories and approaches to 
learning which tends to lessen the intent 
of the reader; however. there are many 
good ideas discussed in the chapter on 
'Teaching resources". and guidelines as 
to using the many resources available 
today. A chapter on "Teaching 
psychiatric nursing" is applicable to any 
clinical situation and not specific to 
psychiatry; the use of role playas a 
teaching device, however is discussed on 
a most superficial level. Guidelines 
which would have been useful for 
teachers are missing which is 
unfortunate since this method can offer 
so much toward the development of 
empathy, self-awareness and 
attitude-change. Few books are written 
on teaching clinical nursing and this is a 
useful library addition because of the 
many practical guidelines it offers for 
sound planning. 

Reviewed by Kathleen Young, R.N., 
B.Ed., Teaching master, Seneca Col/ege 
Schoolo/Nursing, Willowdale, Ontarioo 



Antiflatulent Simethicone 

OVOl is indicated to relieve bloating, 
flalulence and other symptoms 
caused by gas retention including 
aerophagia and infant colic. 
None reported. 
Protect OVOl DROPS from freezing. 
None reported. 
Simethicone 80 mg 
Simethicone 40 mg 
Adults: One chewable tablet between 
meals as required. 
Simethicone (in a peppennint 
flavoured base) 40 mg/ml 
Infants: One-quarter to one-half ml as 
required. May be added to fonnula or 
given directly from dropper. 

Y Montreal Canada 

Books for a new 
decade of nursing. 

Klaus & Fanaroff 
2nd Edition 
Patterned after the highly successful 
first edition, this new rigorously 
revised and updated second edition 
further bridges the gap between the 
physiologic principles and clinical 
management in neonatology. Popular 
features, such as critical comments 
on controversial points, case material 
and question-answer exercises that 
apply information from each chapter 
have been retained. 
By Marshall H. Klaus, MD, Prof. of Pediatrics: 
and Avroy A. Fanøroff. MB, (RAND). MRCPE. 
Assoc. Prof. of Pediatrics, both of Case Western 
Reserve Univ. School of Medicine, Cleveland, 
OH. 437 pp. lIIustd. 523.40. July 1979. 


Here's an approach that allows readers 
to apply problem-solving skills to 
medical-surgical nursing-and it's been 
class-tested as well! Corbett & 
Beveridge offers an exhaustive 
treatment of six decision trees in a 
unique learning format. Readers are 
guided through these clinical situations 
using a series of self-testing questions 
to examine decision-making skills. 
As readers progress, they encounter 
rationales for both correct and incor- 
rect action. The volume functions as 
an adjunct to courses on any level, as 
well as for self-teaching and review. 

By Nancy Ann Corbett, RN, EdM, Assoc. Prof., 
College of Allied Health Sciences. Thomas 
Jefferson Univ., Phila.. PA; and Phyllis Beveridge; 
RN, EdM, Lecturer, College of Health Sciences. 
Univ. of Bridgeport, CT. 332 pp. Soft cover. 
511.95. January 1980 Order 

r ------------------- ..., 
To order titles on 3D-day approval CN 1/80 
I ent er ordpr ::;: and author 
I Full Name 
I PosItion and Affiliation (If Applicable) 
I Home Address 
I CIty 
I Signature I 
L _ W.B. Saunders Company_ _ _ _..J 
1 Goldthorne Ave., Toronto, Ontario M8Z 5T9 

Keane & Fletcher 
4th Edition 
This unique programed text presents 
material in short steps with immediate 
feedback and reinforcement. You'll find 
ratio and proportion for solving all 
problems with no fomulas to memorize. 
Additionally, you'll find all mathematics 
necessary for you to know in medication 
By Claire B. Keane, RN. BS. MEd; and Sybil M. 
Fletcher, RN. BS. About 170 pp. Illustd. Soft 
cover. About 59.00. Ready soon Order 

Tilkian & Conover 
Here's an exciting package that pro- 
vides a basic familiarity with normal 
heart sounds and allows recognition of 
life-threatening disorders manifested 
by abnormal heart sounds. Package 
includes G-60 cassette plus soft cover 
By Ara G. Tllkian, MD, FACC, Asst Clinical Prof. 
of Medicine (Cardiology), Univ. of California 
School of Medicine. Los Angeles; and Mary 
Boudreau Conover, RN, BSN, Ed, Instructor of 
Critical Care Nursing and Advanced Arrhythmia 
Workshops. West Hills Hospital and West Park 
Hospital, Canoga Park, CA. Book only: 122 pp. 
lIIustd. Soft cover. 510.95. April 1979. 
Order ff8869-1. Package: 520.35. Order 

I I 

Drain & Shipley 
Two leading experts provide clear. 
accurate coverage of the recovery room 
in this exciting book. Topics include the 
physiology of anesthesia, the effects of 
various anesthetic agents. specific care 
after all types of operations. and factors 
that affect recovery from anesthesia in 
particular patients. 
By Cecil B. Drain. RN. CRNA. BSN. Major, Army 
Nurse Corps, U niv. of Arizona, Tucson; and Susan 
B. Shipley, RN, MSN, Major, Army Nurse Corps; 
Nurse Researcher. Walter Reed Army Medical 
Center, Washington, DC. 608 pp. 167 ill. 520.35. 
March 1979. Order 'ff3186-X. 

A unique new learning concept for 
nurses! This one-of-a-kind manual pro- 
vides an excellent foundation for 
studying the nursing process in main- 
taining basic functions, from respiratory 
and nutritional. . . to psycho-social 
and eleëtfolyte status. Six major units 
are divided into modules, each with its 
own glossary, objectives, self-tests, 
post-tests, and answers. Excellent for 
use in a traditional learning environ- 
ment, or for an independent, self-paced 
program. Instructor's guide available 
By Eloise R. Lee, RN, MEd, Asst. Prof., Cedar 
Crest College. School of Nursing. Allentown, PA. 
About 450 pp Soft cover. About 513.80. Ready 
soon Order 

I I 

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I = Enter my 5ub.:;cnptlon to 
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Documenting patient care 
responsibly Skillbook Series, 
Nursing '78 Books, Horsham, 
Pennsylvania, Intenned 
Communications, Inc., 1978, 
191 pages. 
Approximate price $8.95, 

Documenting patient care 
responsibly is one volume of the Nursing 
Skill book Series intended for education 
in nursing in order to provide quality 
patient care. There are nine authors, and 
more than twenty-five contributors, but 
the presentation style remains consistent 
and well integrated throughout. Like the 
previous Nursing Skillbooks, this book is 
rich in the use of visual aides, 
caricatures, anecdotes, charts, graphs 
and summaries. The text is easy to read, 
easy to follow and enjoyable to learn 
Self assessment of learning is 
provided in the form of Skillchecks 
which are multiple choice questions at 
the conclusion of each section. 
Answering the Skillchecks requires 
synthesis and application of information 
in simulated situations. Answers and the 
appropriate rationale are provided at the 
end of the text. 
Not a book intended to teach or 
improve skills in traditional 
source-oriented charting, it explains and 
clearly outlines a viable alternative 
which is gaining increasingly widespread 
acceptance - the SOAPIER method: S - 
subjective data (what the patient says he 
feels), 0 - objective data (what you 
observe and inspect), A - assessment 
(ongoing), P - plan,) - implementation of 
the plan, E - evaluation of the 
implemented plan and R - revision. 
Problem oriented medical records 
(POMR) first introduced by Dr. 
Lawrence L. Weed in 1958, is the basic 
theory upon which the text is basedo 
The book begins with an overview 
of the nursing process; this is a valuable 
and concise review for students and 
active graduates or a sound introduction 
for nurses returning to practice. The 
authors emphasize throughout that 
charting according to the nursing process 
is essential in order to provide quality 
patient care. 
The text proceeds systematically 
and progressively through the phases of 
data collection, assessment, identifying 
needs, planning care, recording progress 
and evaluating the plan. Legal 
considerations are also incorporated 
within each section. 
The bias of this text is clearly 
against source-oriented charting and 
toward POMR. It would appear that the 
use of POMR is becoming increasingly 
popular and it is therefore imperative for 
nurses to update their skills 
independently or as part of a continuing 

education program. Documenting patient 
care responsibly is suitable for use in 
either way and would also be a valuable 
reference source for those individuals or 
institutions interested in implementing 
the POMR system of documentationo 

Reviewed by Susan J. Carmichael, 
lmtructor, Faculty of Nursing, St. Clair 
College of Applied Arts and Technology, 
Windsor, Ontario 

Manual of Critical Care by Linda 
Feiwell Abels, R.N., MoN. St. 
Louis, Mosby, 1979. 

This book is geared to the critical 
care practitioner; it may serve as a 
technical reference for those involved in 
a variety of critical care settings or as a 
resource for nurses being introduced to 
intensive care nursing, and for 
instructors in the special care areas. 
The format is well organized and 
comprehensive. Various aspects of 
critical care are discussed, from life 
maintenance to disaster planning. There 
is, however, limited content on coronary 
care. Since this is purely a technical text, 
it lacks an individualized patient care 
approach and does not provide 
description and specific management of 
major disease processes encountered in 
critical care areas. 
Of special interest is the chapter on 
physical assessment which is very 
informative and systematically 
approached and there is a thorough 
description oflaboratory tests commonJy 
used in intensive care areas for quick 
reference 0 
The author also presents an in-depth 
discussion of basic and complex nursing 
procedures and equipment which would 
be useful, not onJy in critical care areas, 
but also in a general ward setting. 
Included are numerous illustrations and 
Each chapter has a comprehensive 
bibliography and the book ends with 
appendices on cardIac rhythms with 
indications for treatment, as well as a 
summary of various drugs. 
Overall, this book is worthwhile 
reading for anyone providing care to the 
critically ill patient. 

'iewed by Emma C. Glua, R.N., 
Nurse Clinician, Coronary Care Unit, 
Vancouver General Hospital. 
Emergency first aid, safety oriented 
[Ottawa] St. John Ambulance, 

This new St. John Ambulance First 
Aid Manual is dedicated, as its title 
would indicate, to the teaching of 
emergency first aid and personal safety 
precautions. As expressed in Dr. Salter's 
foreward, the "ultimate goal of St. John 

in Canada is to provide at least the basic 
concepts of First Aid and Safety to every 
trainable citizen in the country". To 
achieve this purpose, the practice of first 
aid is presented within the framework of 
loss control; in its effort to prevent loss 
offife, of health, of productive time and 
of money to the individual, to the 
community, and to the country at large. 
The manual subscribes to the belief that 
accidents leading to the need for first aid 
are often avoidable when reasonable 
precautions are exercised. 
Indeed, the most unique feature of 
this fIrst aid manual is its attention to 
safety and preventive measures 
throughout. Together with descriptions 
and illustrations for practical modes of 
emergency treatment, the authors have 
presented methods of preventing injury 
such as common household and 
industrial accidents, as well as our 
classic environmental injuries. For 
example, the chapter which includes 
cold exposure comes complete with 
temperature chart, index of wind chill 
factors, and advice on suitable clothing. 
The infonnation presented is readily 
understandable, and would well serve as 
a handy reference manual for 
professionals and non-professionals 
alike. ) was pleased to see the inclusion 
of the abdominal and chest thrust 
procedures for victims of choking, and 
would recommend that anyone likely to 
make use of cardiopulmonary 
resuscitation should explore the St. John 
Ambulance special course or request 
additional instructional materials as 
explained on page forty of the manual. 
Pertaining to safety in another 
dimension, the authors do not fail to 
point out situations where the first aider 
is limited in his intervention skill, and 
thus where professional help must be 
sought immediately. 
Several strong features of this 
publication are the modification of 
various emergency procedures when 
applied to children versus adults, an 
explanation of the importance of 
listening and talking to the conscious 
victim, of making assessments, and 
setting priorities. 
However, my highest 
recommendation of the book would be 
given for its promotion of personal safety 
attitudes and practices, which most of us 
violate from time to time. 
The rationale upon which this safety 
oriented manual is based, can best be 
summarized in this introductory quote: 
"First Aid strives to minimize or 
overcome the effects of unsafe acts or 
unsafe conditions which have in the past 
been considered uncontrollable." 

Reviewed by Cheryl Ann Lapp, graduate 
student, Advanced Public Health 
Nursing, School of Public Health, 
University of Minnesota. 

56 Jenuary 1980 

The Cenedlan Nur.e 

When your questions 
involve clinical 
laboratory tests, 
turn to Widmann 
for guidance! 

The brand new eighth edition of Widmann's Clinicallnterpreta- 
tion of Laboratory Tests gives you immediate access to the data 
you need to better understand the selection and interpretation of 
laboratory tests. Widmann cavers the wide range of problems en- 
countered incommunityor hospital practice, discussing widely avail- 
able tests of praven value. No matter Vvhat your questions concern, 
you'll find anslAers in Widmann. From bilirubin tests, blood cultures, 
and oral glucose tolerance tests, to h(MI to establish the fetal 
chromosome complement or h(MIto determine lactose intolerance. 
you will discaver clearly lNTitten, helpful advice reflecting the latest 
clinical understanding of the tests and their significance. And, the 
author is particularly careful to explain Vvhere and h(MI each lab 
test applies to your patient's clinical problems. 
For the eighth edition, Dr. Widmann has completely reorganized the 
book, making it much more practical to use. The book is n(MI di- 
vided into sections, including Hematolog)( Immunolog)( Chemistl\.l 
and Microbiology. The full table of contents (reproduced else'M1ere 
on this page) will sh(MI you the new organization of the book 
The author has also added a great deal of new material to this 
edition. The section on Immunology has been updated to include 
new tests and new understanding of the body's defenses against 
external and internal anack The new material included on blood 
banking explains Vvhat happens to blood Vvhen it is stored. The sec- 
tion on Chemistry deals more extensively than ever with tests that 
are important clinicall)L 
No maner the area of your pradice, maternal-child care, primary 
care, or medical/surgical nursing, you'll find Widmann's Clinical 
Interpretation of Laboratory Tests a handy and reliable source 
of information. 

Titles of Related Interest 

Primary Care 
Cynthia JoAnn Leitch. editor of the journal, The Nurse Practitioner, and 
Richard V. Tinker have organized a team of 19 highly qualified nurses 
and doctors to produce a text ideal for today's nurse practitioner. It ranges 
from evaluallon and management of primary care problems, and primary 
health care of the child, through the management of medical emer- 
gencies, and mental health in primary care. to rehabilitation. By Cynthia 
JoAnn leitch, PhD, RN; and Richard V. Tinker, MD. 589 pp.lllustd. 
$30.00. 1978. 
TABER'S$ Cyclopedic Medical Dictionary, 13th Edition 
With over 47,000 entries, Taber's is unexcelled asa medical and nursing 
dicllonary It features phonetic spelling for mOST entries, iT includes basic 
health questions and answers in 5 languages. and it gives quick access 
to conversion tables, abbreviations, first aid treatments, ele. You'll find 
nutritional values for many foods. an informative appendix and 150 two- 
color illustrations-rendered specifically for this edition. 
Edited by Clayton l. Thomas, MD, MPH. 1784 pp. lIIusld. Thumb- 
indexed. $19. 00. Not thumb- indexed: $17.50 1977. 
Pnces are subject to change 

; CRATC- y
TEST. WiemAnn 


'" I I 
I · 
> }nl 
, I a 
9 I I!I 
a I 

 ! I I I
dl a 
. I 
I , > 
t l j I 

By Frances K. Widmann, MD, Associate Professor of Pathol
University School of Medicine, Durham, North Carolina 
656 pp. IIlustd. $14.50. January 1979. Order #9322-2. 

Table of Contents 
I Hematology: Hematologic Methods; Hemostasis and Tests ofHemo- 
static Function; Diseases of Red Blood Cells; Diseases of White Blood 
Cells: Disorders of Hemostasis. II Immunology: Principles of Immunol- 
ogy and Immunologic Testing; Serology: Selected Immunologic Tests; 
Immunohematology and Blood Banking III Chemistry: GeneralChem- 
istry; Acid-Base and Electrolyte Regulation: Serum EnzymesofDiagnostic 
Importance; Liver Function Tests. IV Microbiology: Microbiologic Ex- 
aminations; Serologic Tests in Microbiology. VEndocrineSystem: The 
Endocrine Glands; Pregnancy. VI Other Tests: Urine, Feces; Sputum; 
Gastric and Duodenal Contents; The Cerebrospinal Fluid. Index. 
r PieãSese
d-;e aëo py õf'i9322=2-widrñãn
sciiñiCãI 1 
Interpretation of Laboratory Tests, 8th Edition ($14.50). I 
Also send the books I have checked below: I 
o '11'5535-5 Leitch & Tinker's Primary Care ($30.00). I 
o *8304-9 Taber's Cyclopedic Medical Dictionary, '13th Edition I 
o *8305-7 Taber's Cyclopedic Medical Dictionary, 13th Edition I 
(not thumb-indexed-$17.50). I 
An invoice wIll accompany the book and will include a small charge for 
postage and handling. 
If you're not completely satisfied. you may return the books in 30 days. 
in good conditIon, 
Full Name 

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should write to: 
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0.:.. _ _ _ _ _ _ _ _ J 

Vulnerable infants: a psychosocial How to write meaningful nursing Learning about epilepsy, by William B. 
dilemma. Edited by Jane Linker standards by Elizabeth J. Mason, Svoboda. Baltimore. University Park Press, 
Schwartz and Lawrence H. 355 pages. Toronto, John Wiley and c1979. 
Schwartz. 378 pages 0 New York. Sons, 1978. Anatomy of an illness as perceived by the 
McGraw-Hili Inc., 19770 patient; renections on healing and 
Approximate price $/0.95 Presented in workbook format, this regeneration, by Norman Cousins. New York, 
The editors of Vulnerable Infants book is designed to help nurses write W.W. Norton,cl979. 
Manual of advanced nursing, by Lorna A. 
have compiled a volume containing meaningful and explicit nursing Schreiber & Marie E. Vlok. 3rd ed. 
twenty-one articles and editorial standards which can be evaluated. Johannesburg,Juta&Co., 1979. 
comment. The collection of articles Three types of standards are Techniques intirmières: une démarche locale 
contains both classic studies and more examined within relative parameters. d'analyse du programme d'enseignement, par 
recent observations from an impressive The type of standard is clearly defined, Madeleine Bureau-Brien. Québec. Collège de 
list of contributors. As well as providing and information is provided on how to Sherbrooke, 1979. 
evidence of the effects of various write the particular standard being Dying in an institution; nurse/patient 
parameters on the outcome of pregnancy discussed in a step-by-step format. An perspectives, by Mary Reardon Castles & 
opportunity for practice is provided for Ruth Beckmann Murray. New York, 
and the subsequent growth and Appleton-Century-Crofts, c 1979. 
development of the high risk infant, the the reader to apply the Information Cancer-causing agents; a preventive guide, 
book draws attention to current moral, gained and answers are also supplied so by Ruth Winter. New York, Crown Pub., 
legal and ethical dilemmas encountered that the reader can evaluate his or her cl979. 
in the health care of high risk infants. progress. Report of the Ninth Ross Roundtable on 
The focus of the book is on the Chapters are developed critical approaches to common pediatric 
psychosocial aspects surrounding high independently, so that the reader can problems in collaboration with the Ambulatory 
risk infancy. Although management of choose a starting point, without having Pediatric Association. School-related health 
care. Columbus. Ohio, Ross Laboratories, 
the problems is not the theme, the to follow a chapter by chapter sequence. c1979. 
various studies, both because of their The chapter on "Validating Voyager en santé sous les tropiques, par 
findings and the variables measured, Standards" demonstrates some Pierre Viens. Montréal, Le médecin du 
provide a wealth of data pertinent to both ambiguity and vagueness and at times is Québec, 1979. 
preventative and management confusing as to procedure. In addition, NaÎtre aujourd'hui. Montreal, Le Médecin 
approaches. although each chapter contains an duQuébec. c1979. 
In the introductory chapter, the introduction of content, and a summary The treatment of hypertension, edited by 
editors point out the dramatic increase in (as well as an acknowledgement in ED. Freis. Baltimore, University Park Press, 
the survival rate ofIow birth weight some), there is no bibliography for Baby surgery; nursing management and 
babies as a result of technological refer.enceso The absence of an index also care, by Daniel G. Young, Eleanor J. Martin 
advances. The crisis of coping with the makes it difficult to locate specific & Barbara F. Weller. 2d ed. Baltimore, Ma., 
high risk infant and his family is thus information 0 University Park Press, cl979. 
encountered with increasing frequency Despite the shortcomings, this book Alcoholism in perspective, edited by Marcus 
by health care professionals both in is of value to nurses who are concerned Grant & Paul Gwinner. Baltimore, Ma., 
hospitals and in the community. U.S. with developing criteria for evaluating University Park Press, c 1979. 
statistics are used to illustrate the scope nursing practice in all settings, and Clinical simulations in nursing practice, by 
of the problem and the economic and should be useful to nursing associations Nancy Ann Corbett & Phyllis Beveridge. 
social costs in that country. who are attempting to determine Toronto, Saunders, 1980. 
standards for practice. '\1anual of pediatric nursing careplans. 
The remaining chapters are well Department of Nursing. The Hospital for Sick 
organizedo Each contains a group of Reviewed by Diane Pechiulis, Associate Children, Toronto, Canada. Edited by U.F. 
articles dealing with one aspect of the Matthews. Boston. Little, Brown, c1979. 
problem preceeded by an editorial professor, Faculty of Nursing, Research in nursing practice, by Donna 
comment highlighting the content of the U niver.
ity of Calgary. Diers. Toronto, Lippincott, cI979. 
articles and bringing findings ofrelated Pharmacology and drug therapy in nursing, 
research studies by other authors. by MortonJ. Rodman & Dorothy W. Smith. 
2d ed. Toronto, Lippincott. c1979. 
The volume is a carefully chosen BOOKS RECEIVED Medical-surgical nursing and related 
selection of articles which clearly physiology, by Jeannette E. Watson. 2d ed. 
illustrates the problems, encourages Listing of a publication does not preclude its Toronto, Saunders, 1979. 
further study and provides direction for subsequent review. Selections for re
'iew will The developmental therapist, by Barbara 
health care. The articles and their be made according to the interests of our Sharpe Banus...et aI. Thorofare, N.J., 
extensive bibliographies provide a rich readers and as space permits. All reviews are Charles B. Slack, c1979. 
and convenient source for any prepared on invitation. Alcohol and your patient; a nurse's 
professional concerned with the handbook, by Madelaine Coates & Gail 
Paech. Toronto, Addiction Research 
problems ofthe high-risk newborn. Le bruit industriel; ses méfaits et son Foundation, 1979. 
Many of the readings are a must for contrôle, par Guy Lescouflair. Québec, Leadership in nursing, edited by MaIjorie 
anyone involved in the planning and Presses de I'Université Laval, 1979. Beyers. Wakefield, Ma., Nursing Resources, 
implementation of perinatal health care Manuel de thérapeutique médicale, par c1979. 
services. In addition the many questions Nicolas V. Costrini. Traduction et adaptation The clinical peñormance examination; 
raised by the editors and contributors de la 22e édition américaine. Paris, Edisem, deveiopment and implementation, by Carrie B. 
call out for more research and the 1979. Lenburg. New York, 
volume should, therefore, provide both Fertilité-contraceptlon-avortement; guide Appleton-Century-Crofts, c1979. "- 
pratique, par École de Service social. 
background and impetus for further Québec, Université Laval, 1979. 
study of problems related to the Mieux vivre avec son enfant, par Nicole *THE LIBRARY'S ACCESSION LIST IS 
vulnerable infant. Dumas et Danielle LeHénaf. Québec, AVAILABLE ON REQUEST WITH A 
Reviewed by J. Alison Rice, Assistant Département de santé communautaire, 1979. STAMPED, SELF-ADDRESSED 
Professor, University of British A history of the council for the education and ENVEWPE. 
Columbia, School of Nursing, training of health visitors, by Elaine Wilkie. 
Vancouver, B.C. Boston. George Allen & Unwin, cl979. 

58 Jenuery 1180 

The C1InI,dl.n Nur.. 



Rqisured :'OIunes required for full time and part time 
employment. Must be eligible rOr registration with 
AARN. Salary and benefits as perU.N.A. Contract. 
Apply in writing to: Miss J. James. Director of 
Nursing. Elnora Genera) Hospital, Elnora, Alberta 
TOM OYO or phone: (403) 773-363
Head Nurse ror Operatinll-EmergenC) Departme
required in a 66-bed active treatment hospItal. ThIs 
nurse must have a number of years of experience in a 
management position. have a Bachelor of Nursing 
Diploma in Administration or post graduate course 
in Operating Room and a Unit Management course. 
Leadership abilities and administration skills essen- 
tial. Salary commensurate with qualifications and 
experience. Position available immediately and will 
remain open until a suitable candidate is selected. 
Apply to: Director or Nursing, Taber General and 
Auxiliary Hospital, Taber, Alberta TOK :!GO. 

British Columbia 

Experienced GenenJ Duty Graduate Nurses required 
for small hospital located N .E. Vancouver Island. 
Maternity experience prererred. Personnel policies 
according to RNABC contract. Residence accom- 
modation available 530 monthly. Apply in writing to: 
Director or Nursing, St. George's Hospital. Box 223, 
Alert Bay. British Columbia, VON lAO. 
Rexlstered IUId Graduate Nunes required for new 
4l-bed acute care hospital, 200 miles north or 
Vancouver, 60 miles from Kamloops. Limited 
furnished accommodation available. Apply: Director 
or Nursing, Ashcroft &; District General Hospital, 
Ashcroft. British Columbia, VOK IAO. 
The "boom" of our northern city continues! We still 
require beginniDll or experienced practitioners for our 
nursing departments. Ir experi,nced, we will give 
you opportunity to try some of your ideas. If 
beginning. we will give you opportunity to expand 
your skills and knowledge. Contact: Mrs. A. 
Henriksen. Nursing Director. Dawson Creek and 
District Hospital, 11100 13th Street, Dawson Creek, 
British Columbia VlG 3W8. 

General Duty Nurse for modem 35-bed hospital 
located in southern B.C. 's Boundary Area with 
excellent recreation facilities. Salary and personnel 
policies m accordance with RNABe. Comfortable 
Nutse's home. Apply: Director or Nursing, Bound- 
ary Hospital, Grand Forks, British Columbia, VOH 

General Duty Registered Nunes required for 108 bed 
accredited hospital. Previous experience desirable. 
Salary as per R.N.A.B.e. Contract with nonhern 
allowance. For further information please con 
tact: Director of Nursing, Kitimat General Hos 
pital, 899 Lahakas Boulevard N., Kitimat, B.e. 
Experienced Nunes (B.e. Registered) required ror a 
newly expanded 463-bed acute, teaching, regional 
referral hospital located in the Fraser Valley, 20 
minutes by freeway from Vancouver, and within 
easy access of various recreational facilities. Excel- 
lent orientation and continuing education program- 
mes. Salary-I979 rates-51305.00--51542.oo per 
month. Clinical areas include: Operating Room, Re- 
covery Room, Intensive Care, Coronary Care. 
Neonatal Intensive Care, Hemodialysis, Acute 
Medicine, Surgery, Pediatrics, Rehabilitation and 
Emergency. Apply to: Employment Manager, Royal 
Columbian Hospital, 330 E. Columbia St., New 
Westminster, British Columbia, V3L 3W7. 
Experienced Nunes (eligible for B.e. Registration) 
required for full-time positions in our modem 
300-bed Extended Care Hospital located just thirty 
minutes !"rom downtown Vancouver. Salary and 
benefits according to RNABC contract. Applicants 
may telephone 525-0911 to arrange for an interview, 
or write giving rull particulars to: Personnel Direc- 
tor, Queen's Park Hospital. 315 McBride Blvd., 
New Westminster, British Columbia, V3L 5E8. 

British Columbia 

Nurslnll r. rsonnel required immediately for a 
number 0 positions, all areas. rull time and relief 
available. Eligibility for registration in B.e. re- 
quired. Contact: Director of Nursing. Mission 
Memorial Hospital. 7324 Hurd Street. Mission, 
British Columbia V2V 3H5. Phone: (604) 826-6261. 

Regisured Nurses required for both acute and 
extended care in a l25-bed hospital in the South 
Okanagan. Experience in obstetrics and medical- 
surgical prererred. RNABC contract in effect. Apply 
stating qualifications and experience to: Nursmg 
Administrator, South Okanagan General Hospital, 
Box 760. Oliver. British Columbia. VOH lTO. Phone: 

Experienced General Duty :'O/unes required for 
13O-bed hospital. Basic Salary 51.305.00--51.542.00 
per month. Policies in accordance with RNABC 
Contract. Residence accommodation available. 
Apply in writing to: Director of Nursing, Powell 
River General Hospital, 5871 Arbutus Avenue, 
Powell River. British Columbia V8A 4S3. 

Registered Nurses required immediately for a 340- 
bed accredited hospital in the Central Interior of 
B.e. Registered Nurses interested in nursing posi- 
tions at the Prince George Regional Hospital are 
invited to make inquiries to: Director of Personnel 
Services, Prince George Regional Hospital. 2000- 
15th Avenue. Prince George, British Columbia, 
V2M lS2. 

Registered Nurses required for permanent fulltime 
position at a l47-bed fully accredited regional acute 
care hospital in B.e. Salary at 1979 RNABC rate 
plus northern living allowance. One year experience 
preferred. Apply: Director or Nursing. Prince 
Rupert Regional Hospital, 1305 Summit Avenue, 
Prince Rupert, British Columbia, V8J 2A6. Tele- 
phone (collect) (604) 624-2171 Local 227. 

General Duty RN's or Graduate Nurses for 54-bed 
Extended Care Unit located six miles from Dawson 
Creek. Residence accommodation available. Salary 
and personnel policies according to RNABC. Apply: 
Director of Nursing, Pouce Coupe Community 
Hospital, Box 98, Pouce Coupe. BritIsh Columbia or 
call collect (604) 786-5791. 

ExperieDced maternity, 'oC.U./C.C.Uo, IUId Operat- 
in. Room General Duty nunes required for IOJ-bed 
accredited hospital in Northern B.C. Must be 
eligible for B.c. registration. Apply in writing to the: 
Director or Nurses, Mills Memorial Hospital, 4720 
Haugland Avenue, Terrace. British Columbia, V8G 

Instructor-Post Basic: Obstetrical Nursing. Full time 
instructor required immediately to help develop and 
teach a unique and innovative Post Basic Obstetrical 
Nursing course with an emphasis upon the intrapar- 
tum period. The successful applicant will be 
responsible for working cooperatively with another 
full time instructor to develop and implement a 
curriculum for nurses working with both normal and 
high risk mothers and fetus/newborns. NOn tradi- 
tional methods or teaching will be used. including 
independent learning mOdules and distance learning. 
The instructor must be willing to look beyond 
tradItional methods of nursing education to reach 
working nurses and nurses throughout the province. 
Preference will be given to Registered Nurses with 
post basic preparation in obstetrics or midwifery, 
recent clinical experience in the caseroom or high 
risk nursery. A BScN, and experience in teaching 
and curriculum dowelopment. Competitive salary 
and excellent fringe benefits. Please submit resume 
to: Barbara Mills. Coordinator, Continuing Nursing 
Education. Vancouver Community College, Lan- 
gara Office. 100 West 49th Avenue. Vancouver, 
BritIsh Columbia V5Y '1Z6. Phone: 324-5406. 

The Canadian Nurse 

British Columbia 

General Duty Nunes required for an active. IOJ-bed 
hospital. Positions available for experienced R.N's 
and recent Graduates in a variety of areas. RNABC 
Contract in effect. Accommodation available. Apply 
to: Director or Nursing. Mills Memorial Hospital. 
4720 Haugland Avenue. Temlce. British Columbia 
V8G 2W7. 

l'niverslty or Victoria, School or Nurslnllo Applica- 
tions are invited for positions On the raculty of the 
School of Nursing, University of Victoria. The 
School offers a two-year post-R.N. programme 
leading to a B.Sc.N. and plans to develop both a 
basic and a master's programme. Qualifications: 
Master's degree required. doctorate preferred. Ex- 
perience in university teaching an asset. Apply to: 
Director. School of Nursing. University of Victoria. 
P.O. Box 1700, Victoria. British Columbia V8W 


Chllllrng1ng c.ner Opportunh,. ror Rellstered 
ursa In 
Can.d."s 'orth - ^ 100 bed acute care hospital in 
\faniroba which services Thompson and several small 
communities in the surrounding area has immediate vacan- 
cies in Pediatrics. Medicine/Surgery. Obstetric, and Cntical 
Care. This opportunity will appeal to nurses who wdnt to 
increase their existing skills or develop new skills through our 
comprehensive in service program. Many of our nurses have 
become experienced in flight nursing_ Candidates must be 
eligible for provincial registration as acti\e practicing 
members. We otTer an excellent range of benefits. including 
free dental plan. accident. health and group life insurance. 
Salary range is 51.018 - 51.340 per monlh dependenl on 
tjualifications and expenence plus a remoteness allowance. 
Apply in writing or phone: \fr. R. L. In ine. DireclOr of 
onnel. Thompson General Hospital. Thompson, Man- 
iloba. R8N OR8. Phone: (204) 611-

Northwest Territories 

The Stanton Yellowknife Hospital, a 72-bed accre- 
dited, acute care hospital requires registered nurses to 
work in medical. surgical, pedlatIic, obstetrical or 
operating room areas. Excellent orientation and 
inservice education. Some rurnished accommoda- 
tion available. Apply: Assistant Administrator- 
Nursing. Stanton Yellowknife Hospital, Box 10, 
Yellowknife, N. W.T., XIA 2N L 


Applications are now being accepted by the Ontario 
Society ror Crippled Children ror Registered Nunes, 
Graduate NUl"Ses Illld Registered Nursinll Assistants 
ror their Resident Summer Camps located near 
Collingwood, Port Colborne. Perth, Kirkland Lake 
and London. Ten weeks - mid June to late August, 
1980. Various positions available - Supervisory, 
Assistant supervisory, and general cabin respon- 
sibilities. Contact: Camping and Recreation De- 
partment. 350 Rumsey Road, Toronto. Ontario M4G 
lR8. (416) 425-6220, ext. 242. 

RN, GRAD or RNA, 5'6" or over and strong, 
without dependents, non-smoker, for 185 lb. hand- 
icapped retired executive with stroke. Able to 
transfer patient to wheelcl.air. live in 1/2 yr. in 
Toronto and 1/2 yr. in Miami. Wages: 5200.00 to 
5275.00 wkly. NET plus 590.00 wkly. bonus on most 
weeks in Miami. Write: M.D.C., 3532 Eglinton 
A venue West, Toronto, Ontario, M6M lV6. 


red N_ for summer camp in the Lauren- 
tians, mid-June to end or August. Congenial sur- 
roundings. Resident doctor. Contact: Myron Good- 
man, Executive Director, YM-YWHA Wooden 
Acres Camp, 5500 Westbury Avenue, Montreal. 
Quebec H3W 2W8. Telephone: (514) 737-6551. 
Local 5I. 

JanullfV 1980 59 


Camp Nurses required for chlldren's summer camp 
in beautiful Quebec Laurentians. Mid-June to end of 
August. Resident M.D. Contact: Mr. Herb Finkel- 
berg. Director of Camp B'Nai B'Rith. 5151 Cote St. 
Catherine Rd., Suite 203. Montreal. Quebec H3W 
lM6. ortelephone(514) 735-3669. 


Required immediately three full time Registered 
Nurses for 26-bed general duty active treatment 
hospital in northwestern Saskatchewan. Salary and 
benefits per current S.U.N. Contract. Apply to: 
Miss Theresa Ste. Marie. Director of Nursing, 
Riverside Memorial Union Hospital. Turtleford, 
Saskatchewan SOM 2YO. 

R.N.'s and R.P.N.'s leligible for Saskatchewan 
registration) required for 340 fully accredited eX- 
tended care ho'pitaL For further information. 
contact: Personnel Depanment. Souris Valley Ex- 
tended Care Hospital. Box 201H. Weyburn. Sas- 
katchewan S4H 2L7. 

United States 

R.N.'. UoSoAo - Dunhill with 250 offices has 
exciting career opportunities for both recent grads 
and experienced R.N.'s. Locations North, South, 
East and West. All fees are paid by the employer. 
Send your resume to: 801 Empire Building. Edmon- 
ton, Alberta, T5J IV9. 

Total patient care with all licensed personnel is Our 
goal' Starr RNs currently interviewing fOr part-time 
and full-time positions. Full service, except psych. 
progressive 156-bed accredited acute general hospi- 
tal. Located within 60 minutes from LA, the ocean. 
mtns.. and the desert. Orientation and staff de- 
velopment programs. CEUs provider number. 
Par1cview Community Hospital. 3865 Jackson Street. 
Riverside. California 92503. Write or call collect 
714-688-2211 ext. 217. Betty Van Aernam, Director 
of Nursing. 

tlDrida NunlDI Opportunities - MRA is recruiting 
Registered Nurses and recent Graduates for hospital 
positions in cities such as Tampa, St. Petersburg, 
and Sarasota on the West Coast; Miami, Ft. 
Lauderdale and West Palm Beach on the East Coast. 
If you are considering a move to sunny Florida, 
contact our Nurse Recruiter for assistance in 
selecting the right hospital and city for you. We will 
provide complete Work Visa and State Licensure 
information and offer relocation hints. There is nO 
placement fee to you. Write or call Mrdkal 
ItKrultrnor Amrrka, Inco (For West Coast) I211 N. 
Westshore Blvd., Suite 205, Tampa. FL 33607 (813) 
g72'{)202; (For East Coast) 800 N.W. 62nd St., Suite 
510, Ft. Lauderdale, F1. 33309 (305) 772-3680. 

RN'S - Our Florida hospitals need you! Join the 
many Canadian RN's who are currently eflioying 
Florida's Gulf Coast beaches. sun. and exciting 
recreational activities. We will provide work visas. 
help you locate a position. find housing. and arrnnge 
your relocation. No Fees! Call Or write: Medical 
Recruiters of America. 1211 N. Westshore Blvd., 
Suite 205. Tampa, Florida 33607 -(813) 872-0202. 

Nur.. - RN. - Immediate Openings in 
CaJifornia-Florida-Texas-Mississippi - if you are 
experienced or a recent Graduate Nurse we can offer 
you positions with excellent salaries of up to $1300 
per month plus all benefits. Not only are there no 
fees to you whatsoever for placing you, but we also 
provide complete Visa and Licensure assistance at 
also nO cost to you. Write immediately for our 
application even if there are other areas of the U. S. 
that you are interested in. We will call you upon 
receipt of your application in order to arrange for 
hospital interviews. You can call us collect if you are 
an RN who is licensed by examination in Canada Or 
a recent graduate from any Canadian School of 
Nursing. Windsor Nurse Placement Service, P.O. 
Box 1133. Great Neck. New York. 11023. (516- 
"Our 20th Year of World Wide Service" 

BO .J.nuarv 1QAn 


Departm<:nl of Health and Communily Services 
The School or Psychiatric Nursing, 
Selkirk Mental Health Centre 
Is orrerlng a Post - Basic Course in 
Psychiatric Nursing 
Registered Nurses currently licensed in Man- 
itoba Or eligible to be SO licensed. with 
University credits in Introductory Psychology 
and Introductory Sociology. 
The course is of ten months duration Sep- 
tember through June. and includes theory and 
clinical experience in hospitals and community 
agencies. as well as six weeks nursing of the 
mentally retarded. 
Successful completion of the program leads to 
eligibility for licensure with the R.P.N.A.M., 
as a Registered Psychiatric Nurse (R.P.N.). 
For further information please write: 
Director of Nunlng Educldlon 
School ofP.ychhdrl< Nunlng 
Box 9600 

lkln, Manitoba RtA lB5 

Before accepting any 
position in the U.S.A. 
We Can Otter You: 
A) Selection of hospitals throughout 
the USA 
B) Extensive information regarding 
HospitaJ-- Area, Cost of livIng. erc 
C) Complete Licensure and Visa Service 
Our Services to you are at 
absolutely no tee to you. 

P.O. BOI 1133 Great Neck. N.Y. 11023 
(516) 487-2818 

 Our 20th Year of World Wide Service 

Wateñord Hospital 
Career Opportunities For 

The W
lcrford HO"Plldl. a fully .u:crcdilcd .sno 
bed P'}Chldlnc Im,lllulion. afTillalcd with 
McmoridJVn'\Cr"ll) Sclloolo(Nur...ngi:lnd 
'1cdiul School. ha'li opcnm
" for Rrg'''lcred 
Nur..c, :0 all \crviccs. including or",". 
c"-p.mdcd. élnd acute care "CTVICC\ 
A.n OrlenlallO" program i.. offered. 

dldr) ., on the ..calc ofSI
 - l.s_"i

annum A P'ychi,dnc Service ,.t:,lIo"".,ncc of 
SI.129prr annum 1'\ 3"allatllc III addlflon to 
ba'lolc "'diary. Both ,alar)' and 'I.lIowancc 
presently under fC" ICW 
The HO'lOptlal.", do'l.c to all dmcnillc"", 
..hopping. tran\ponation and recreallon 
Accommodation'\; avallatllc In Ho""pilal 
ldrncr al nomma) ('0". 
Apphcóltlon.. In wntln
 'liiihouid he addre'liii'lr,ed 10 
Ihe under'lr,igned 
PnsoRMI Dint'lor 
'htrrford JlOOipltal 
Walrrford Brid
SI. John's. N
41E .ua 
Trle-phoM Num
r: (7091 368-6061, rJl.I. 341 

Th. r.n.I1IA" NI.".. 

United States 

Dallas, Houston, Corpus Christi, etc. etc. etc. The 
eyes of Texa\ beckon RN's and new grad, to 
practice their profession in one of the most 
prosperous areas of the U.S. We represent all size 
hospitals in virtually every Texas and Southwest 
U.S. City. Excellent salaries and paid relocation 
expenses are just two of many super benefits 
offered. We will visit many Canadian cities soon to 
interview and hire. So we may know of your 
interest. won't you contact us today? Call or write: 
Ms. Kennedy. P.O. Box 5R44. Arlington. Texas 
76011. (214)647-0077. 

Come to Texas - Baptist Hospital of Southeast 
Texas is a 400-bed growth oriented organization 
looking for a few good R.N .'s. We feel that we can 
offer you the challenge and opportunity to develop 
and continue your professional growth. We are 
located in Beaumont, a city of 150.000 with a small 
town atmosphere but the convenience of the large 
city. We're 30 minutes from the Gulf of Mexico and 
surrounded by beautiful trees and inland lakes. 
Baptist Hospital has a progress salary plan plus a 
liberal fringe package. We will provide your immig- 
ration paperwork cost plus airfare to relocate. For 
additional information, contact: Personnel Ad- 
ministration, Baptist Hospital of Southeast Texas. 
Inc., P.O. Drawer 1591, Beaumont, Texas 77704. An 
amnaatIve action employer. 

Excitement: Come and join us for year around 
excitement on the border. by the sea. an unbeatable 
combination. Enjoy the sandy beaches of So. Padre 
Island or the unique cultures of Old Mexico. Our 
new 117-bed. acute care hospital offers the experi- 
enced nurse and the newly graduated nurse an array 
of opportunities. We have immediate openings in all 
areas. Excellent salary and fringe benefits. We invite 
you to share the challenge ahead. Assistance with 
travel expenses. Write or call collect: Joe R. Lacher. 
RN. Director of Nurses, Valley Community Hospi- 
tal. P.O. Box 4695. Brownsville. Texas 78521; I 
(512\ 831-9611. 

Registered Nunrso We invite you to join our health 
care team at Leon County Memorial Hospital. Inc., 
a 36 bed acute care facility in Buffalo. Texas, located 
in the Lone Star State's scenic counlry hillside of 
east Central Texas. We will provide you with a 
challenging professional opportunity as a nurse 
involved in our high level. quality patient care 
programs. Excellent starting salary; equitable .shift 
differentials; group employee benefits; educational 
opportunities; and reasonable relocation expenses. 
H-I Visa assistance provided. Please contact: 
Director of Nurses. P.O. Box 159. Buffalo. Texas 
75831. Phone 214/322-4231. 

Nurses - RNs - A choice of localions with 
emphasis on the Sunbelt. You must b
 licensed by 
examination in Canada. We prepare VISa forms and 
provide assistance with licensure at nO cost to you. 
Write for a free job market survey Or call collect 
(713) 789-1550. Marilyn Blaker, Medex, 5805 
Richmond. Houston, Texas 77057. All fee, employer 

Nurse Midwives - Overseas: Project HOPE seeks a 
Midwife Nurse Educator for Egypt. ThIS person 
would need a Master's Degree. Midwifery Certifica- 
tion and 2-5 years teaching experience. It will offer 
the challenge of working with an Egyptian. counter- 
part in curriculum development and exp
s.on of the 
midwifery program. Project HOPE prov.
es. excel- 
lent benefits. negotiable salary. travel. sh,pplng and 
storage. Send resume to: Personnel Depanment, 
Project HOPE. Millwood, Virginia 22646. E.O.E. 


I wish to contact any members ofthe student nurses' 
class at The Toronto East General Hospital. 
Toronto, Ontario, for the years 1960 to 1963. Write 
to: Basement Suite, 424 East 37th Avenue. Van- 
couver. British Columbia. V5W IE9. 




Registered Nurse Applicants For Overseas Jobs 
Hospital Corporation International 
Some Advice On Seeking Employment In The Field Of 
International Nursing. 

Who is doing the inteniewing 
and recruiting? What is their 
experience and background? 
Make sure you are dealing with a 
reputable organization that is a true 
representdtive of your prospective 
employer. Be sure they have first 
hand knowledge of the location and 
facilities where you'd be living and 

How realistic is the 
information and how much is offered 
about the job, the working 
conditions, culture, etc? 
Ifit all sounds exciting. glamorous, 
and positive, then the picture isn't 
realislic, it's "rose-colored". It can 
be adventurous and rewarding. but 
there are day to day drawbacks. 
frustrations, and difficulties to 
consider before you decide to go. 
And you should be told about all the 
details - don' t accept 

Many organizations are offering overseas job opportunities in the health and hospital field these days 0 If you 
are interested and seriously considering an overseas or international assignment. here are some important 
points to consider and questions to ask - before and at your interview: 

Willi have to pay an 
 ment fee? If so, 
for what and "hy? 
Some independent agencies will 
charge you a sizeable fee just to 
send your resume somewhere else 
and can make no commitment to 
you. Other organizations do their 
own recruitmg or can make 
commitments and they won't charge 
you an employment feeo 

Willi be offered an) 
assistance in preparing for overseas 
relocation, employment, and 
adapting to the new environment? 
Experienced, reputable 
organizations will show concern for 
you as an individual- and for your 
ultimate success - by assisting you 
with pre-departure processing 
requirements and preparations and 
by providing comprehensive 
pre-departure and post-arrival 
orientation programs. 


Hospital.Corporation Internalional, a member of the Hospital Corporation of America Group, is one of the most experienced and 
professional organizations providing international recruitment and human resource services in the health care and hospital related field 
I f you are thinking about an overseas assignment. we invite you to explore the possibilities by explonng Hospital Corporation 
International. Ask us the questions; we'll give you the answers. You owe it to yourself. 
If you are interested and would like more information, please send your resume to: 
International Human Resource Management (7) 
Hospital Corporation International 
One Park Plaza 
iIIe, Tennessee 37203 

What kind of organization or 
company am I dealing with? What 
is its primary business? 
Ifit isn't the Health Care Business, 
first and foremost. you may want to 
investigate further: What are their 
qualifications, experience, 
standards, quality, etc? 

Willi be offered an) 
assistance to relocate in another job 
when my contract is finished? 
Find out if the company can help 
you "get back in touch" after being 
away from home for two or more 
yearso It's an important point that 
many individuals overlook - and so 
do many companieso 

 -.' . 
L _ 

An Equal Opportunity Employer 

Centracare Saint John, Inc. 

This 500-bed Psychiatric Hospital is inviting applications 

Registered Nurses 


AIl Units - Acute, Rehabilitation, Geriatric and Infirmary 

Qualifications Required: 
Graduation from an approved School of Nursing, registered 
or eligible for registration in the Province of New Brunswick. 
Post-graduate preparation in Psychiatric Nursing would be an 
asset. Competence in English is essential. 

$11,208 to $16,740 per annum, commensurate with 
qualifications and experience. 


As per the CoIlective Agreement, including pension plan, sick 
leave and vacation leave. 

Apply To: 

Personnel Office 
Centracare Saint John, Inc. 
P.O. Box 3220 
Saint John 
New Brunswick 
E2M 4H7 Competition No. 

CSJ 79-28 

I I 
: ..T0111t)C1UW S." 
iog.. . 

City State 7 ip_ 
Graduate Of 
AA_BS_Dip_Yr _ 
Area of Interest 

I':W':! -r 
"> ... - 

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I> .:.: : 



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...;.,___ -- . 

62 Januery 1980 

Assistant Supervisor 
Psychiatric Nursing 

Applications are being accepted for the above position. The 
successful applicant will provide innovative, creative 
leadership in the planning, development, implementation and 
evalualion of quality assurance and slaff development 
programs for the depanment. The incumbent wiII also give 
clinical supervision in the areas of special expenise. 

Applicants must be eligible for registration in British 
Columbiao MSN degree is preferred and BSN degree is 
required. Demonstrated administrative ability, including 
skills in leadership and interpersonal relations is required, 
plus expen specialized clinical nursing skills. Advanced 
competence in nursing education is essential. Salary and 
benefits as per RNABC contract. 

Please submit applications to: 

Mrs. J. MacPhail 
Employee Relations Department 
Vancouver General Hospital 
855 W. 12th Avenue 
Vancouver, B.C. 
V5Z IM9 

...is a short drive 


The colorful tastes, sights and sounds of Fisherman's Wharf 
are some of the fascinating things you'll find, ashortdrivefrom 
Stanford University Medical Center. 
You will also find "tomorrow's" nursing today in an exciting 
teaching hospital where non-clinical personnel handle 
administrative and support tasks so you can concentrate on 
progressive nursing. You can apply new techniques, 
participate in research and work with leading authorities in 
every medical specialty. 
We'd like you to know more about our career development 
programs and our excellent compensation package which 
includes an innovative time-off program. For additional 
information, send the coupon to Nurse Recruiter, Personnel 
Department. Stanford University Hospital, Stanford, CA 
94305. Or call collect to (415) 497-7330. For immediate 
consideration, send your resume and salary requirements. We 
are an affirmative action. equal opportunity employer, male & 


Stðnford University 
l\ledical Center 

The Canadian Nuree 

Are You a Nurse? 

Here's an Opportunity To Be One. 

Primary Nursing 
..o..at the New Regional Hospital means having direct 
respOnsibility for the nursing care of your patient, his family, 
and working with the doctor as a coIleague. 

.....as a primary nurse means the outcome of your patient's 
care is the measure of your effectiveness. 

.... .results from your role as a professional and the significant 
pan you play in the care of your patient. 

Pl. IT TOGETHER with the new 300 bed Fon McMurray 
Regional Hospital Opening in November, 1979. 

Want to know more about your opponunities in our total 
patient care facilities? 

CaD Penny Albers at (403) 743-3381 
Write for an information package: 

Personnel Depanment 
Fon McMurray Regional Hospital 
Fon McMurray, Alhena 
T9H IP2 



Saint Anthony Hospital, located in Columbus, Ohio. 
This 4OO-bed acute care facility offers exceIlent opponunities 
for funhering your nursing career. 
No Contracts to Sign 
Rotating Shifts 
Air Fare Paid 
One Month Free Accommodations 
Plus Exciting Challenges 
Saint Anthony, a medical-surgical institution, has a complete 
range of services, including: 
. Open Hean Surgery 
. Intensive and Coronary Care 
. Definitive Observation Unit 
. Renal Dialysis 
. Diagnostic and Therapeutic Radiology 
. 24 Hour Emergency Depanment 
Don't wait, caD or write immediately. 
Make the change to an institution that lets you be what you 
want to be. For fun her information, caIl our Nurse Recruiter, 
Norma Shore, CoDed. 

1200 Lawrence Avenue East 
Suite 301, Don MiDs 
Ontario M3A ICI 
Telephone: (416) 449-S883 


0PP0RTU'm' Æm 


Applications are invited for positions at Alhena Hospital, 
Edmonton, a 650 bed active treatment psychiatric hospital, 
located 4 km. outside of Edmonton. 
Successful candidates must be graduates from a recognized 
School of Nursing and eligible for registration in their 
professional association; willing to worlt shifts. Vacancies exist 
in Admissions, Forensic, Rehabilitation, and Geriatric Services. 
"Iote: Transponation is available to and from Edmonton. 
Accommodation is available in the Staff Residence. 

Salary $ I ,229 - $1,445 per month (Staning salary based on 
experience and education) 

Competition #9184-9 
This competition will remain open until a suitable candidate has 
been selected. 

Qualified persons are invited to phone, write or submit 
applications to: 

Personnel Administrator 
Alberta HospItal, Edmonton 
Box 307, Edmonton, Alberta 
rSj 2J7 
Telephone: (403) 973-2213 

1("'. : . I ' 







The Canadian Nurse 

.JAn..Arv 10M B

Nursing in 
the Sunny Palm Beaches 

Picture yourself in the sunny Palm Beaches 
working at the most prestigious hospital in 
Florida. Good Samaritan Hospital has 
maintained the tradition of being the first in the 
latest hospital services and facilities. Our good 
name and outstanding history attest to our 
A 326 bed, J.C.A.H. accredited hospital 
offering attractive salaries and benefits 

e Active in-service orientation 
e Continuing educational programs 
. 37 1/2 hour week 
e 5 day week 
e No shift rotation 
e Education and experience 
e Fully paid Blue Cross/Blue Shield 
e Shift differential and other employee 
e Seasonal employment welcome 
. Patient-mix 90% under age 65 

We will sponsor the appropriate employment 
Visa for qualified applicants. Attractive 
efficiency apanments available at far below 
commercial rates, overlooking the beautiful 
Lake Wonh and located across the boulevard 
from the hospital. 


Director of Personnel (305) 655-5511 
Good Samaritan Hospital 
Flagler Drive at Palm Beach Lakes Blvd. 
P.O. Box 3166 
West Palm Beach, Fla. 33402 

Head Nurse 
Coronary Care Unit 

Applications are being accepted for the 
above position. The unit consists of a 3 
bed intensive care unit, 10 acute care 
beds and 8 sub-acute care beds. The 
successful applicant will be involved in 
the planning and development of a new 
Coronary Care Unit. 

Applicants should have a minimum of2 
years previous experience in a related 
clinical area plus previous administrative 
experience and preferably hold a BSN. 
Salary scale and benefits according to 
the RNABC agreement. Please submit 
applications to: 

Mrs. J. MacPhail 
Employee Relations Department 
Vancouver General Hospital 
855 W. 12th Avenue 
Vancouver, B.C. 
V5Z IM9 


Health Sciences Centre 
Winnipeg, Manitoba 
invites applications for the position of 
Assistant Director 
Maternal-Child Nursing 

For All 
Clas!iitied Adwrtising 

$20.00 for 6 lines or less 
$3.00 for each additional line 

Rates for display advertisements 
on request. 

Closing date for copy and 
cancellation is 8 weeks prior to 
1st day of publication month. 

The Canadian Nurses 
Association does not review the 
personnel policies ofthe 
hO'ipitals and agencies 
advertising in the Journal. For 
authentic infonnation, 
prospective applicants should 
apply to the Registered Nurses' 
Association of the Province in 
which they are interested in 
Address correspondence to: 

The Canadian Nurse 
50 The Driveway 
Ottawa, Ontario iI!I1!_ 
K2P tE2 ... 

Registered Nurses 

Come to work in scenic Comer Brook! 

Registered nurses are needed for this 350 bed Regional General 
Hospital, with detached 60 bed Special Care Unit, serving the 
West Coast ofNewfoundlando 

This position is open to females and males. 
The Health Sciences Centre, one of the continent's largest 
health care facilities with BOO beds, is Manitoba's principal 
referral institution for complex health problems and the 
province's major hospital for teaching and research. 
The incumbent shall be responsible for the administration of 
nursing services in the Women's Centre, the major high risk 
referral unit for Obstetrics, Neonatology and Gynaecology. 
The Women's Centre has approximately 3500 deliveries a 
year, and 48 gynaecology beds. 
We are seeking an individual who can co-ordinate nursing 
with medical programmes in implementing a common 
philosophy of care, who can participate in the planning of 
new facilities, who can direct and develop nursing staff in the 
use of systems which affect patient care and can develop 
strong interpersonal relationships. 
Candidates require a B.N. (M.N. preferred), demonstrated 
success in an administrative position, a background in the 
above clinical specialities and registration or eligible for 
registration in Manitoba. 
Interested persons should apply in writing including a 
complete resume detailing education and experience to: 
Manager Employment & Training 
Health Sciences Centre 
700 WiUiam A venue 
Winnipeg, Manitoba R3E OZ3 

The hospital offers good fringe benefits such as four weeks 
annual vacation and eight statutory holidays plus birthday 
holiday. In addition there is a hospital pension plan and a group 
insurance plan for all permanent employees. 

Negotiated <;alary Scale: 

Accommodation and assistance with transportation is availableo 

I January, 1979 - $12,77I.oo - 15,429.00 
I Januaryo 1980 - $13,410.00 - 16.199.00 
(Contract not yet signed) 

Service Credits recognized. 

Interested applicants apply to: 

Mrso Shirley M. Dunphy 
Director of Personnel 
Western Memorial Regional HO'ipital 
P.O. Box 200S 
Comer Brook. Newfoundland 
A2H 6J7 

T..... ,......1411... .hIP.. 

A Completely 
Modern Teaching Hospital 


Registered Nurses 



 - -===... --- - 



This 500 bed general hospital is the major 
teaching facility for the Medical School of 
Memorial University of Newfoundland. 

Services offered - 

Critical Care, Medical, Surgical Coronary Care, 
General Surgery, Urology, Gynecology, 
Medicine, Nephrology, Clinical Teaching, 
Neurosciences, Cardiology, Cardiovascular 
Surgery, Orthopedics, Hemodialysis (kidney 
transplants), Emergency and Out Patient 
Services, active Rehabilitation Program (adult). 

The Staff Development and Training Department 
offers ongoing lectures and demonstrations in 
addition to a 6 month diploma Course (twice 
yearly) in -Critical Care Nursing, 
Neurosciences, Operating Room Nursing. 

Located in St. John's, Newfoundland - the 
oldest city in North America with a population of 
120,000, offering cultural and recreation 
activities in a friendly atmosphere. 

Fishing, hunting, boating available 
approximately 10-14 miles outside the city 0 

For information regarding salary and relocation 
expenses and other conditions of employment 
write or cal\ - 

'\1iss Dorothy Mills 
Staffing Officer - Nursing 
The ('..eneraJ HospitaJ 
Prince Philip Drive 
St. John's, NOd. 

Telephone # (709) 737-6450 



This position is open to both men and women. 
Apply in writing referring to Competition 
Number vr 749 immediately. 

Instructor fCurriculum 

Diploma Nursing (Term Position) 

The Department of Education, Keewatin 
Community College, The Pas, is currently 
developing a Diploma Nursing program to train 
northern residents who, upon completion, will be 
eligible to meet M.A. R.N. registration 
requirements. The focus of the program will be 
expertise required to meet health needs of 
northern Manitobanso The Instructor/Curriculum 
Co-ordinator will be responsible for subsequent 
curriculum development. She/he will also 
co-ordinate the implementation ofthe program; 
target date September 1980. Following 
implementation she/he will co-ordinate program 
activities plus carry out instructional activities. 

Master's Degree preferred, or a Bachelor of 
Nursing with relevant experience acceptable. 

Salary Range: $17,759 - $26,496 per annum (Plus 
Remoteness Allowance) 

Personnel Department 
Manitoba Community Colleges 
Room C-416 
2055 Notre Dame A venue 
Winnipeg, Manitoba 
R3H OJ9 

The CanadIen Nur.. 

January 1980 85 


University of Western Ontario 
Faculty of Nursing 

Applications are invited for teaching positions in 
undergraduate and graduate programs. Rank Open. 

Master's or doctorate degree required. Preference will be 
given to candidates with teaching experience and clinical 
specialization. Candidates must be eligible for registration in 

Salary commensurate with preparation and in accordance 
with the University of West em Ontario policies. 
Appointments are subject to availability offunds. 

Send complete resume to: 

Dr. Beverlee Cox, Dean 
Faculty of Nursing 
Health Sciences Addition 
The University of Weslern Ontario 
London, Ontario, N6A 5CJ 

Registered Nurses 

1200 hell ho"'pital adjacent to L 1 niver...ity of 
\lherta campll'" offer... employment in 
medicine, surgery, pediatrics, 
orthopaedics, obstetrics, psychiatry, 
rehabilitation and extended care including: 

. I nten...ive care 
. Coronary oh...ervation unit 
. Cardiova...cular ...urger} 
. Burn... and pla...tic... 
. Neonatal intemive care 
. Renal dialy...i... 
. Neuro-surgery 

Planned Orientation and In-Service Education Programso 
PostGraduate Clinical Courses in Cardiovascular- 
Intensive Care Nursing and Operating Room Nursing. 

Recruitment Offict'r - :'oiuro;ing 
l n;.ersil
 of .\Iht'rla Hospital 

o - I 12th Strt'et 
Edmonton. AItX'rta 
T6(; 2R7 

!f .:'.!!r;o.!'.!!1)' )JI.!!' 

Nursing Opportunities in Vancouver 
Vancouver General Hospital 
If you are a Registered Nurse in search of a change and a challenge _ 
look into nursing opponunities at Vancouver General Hospital. B.C.'s 
m;ijor medical centre on Canada's unconventional West Coast. Staffing 
expansion has resulted in many new nursing positions at all levels, 

General Duty ($1305. - 1542.00 per mo.) 
Nurse Clinician 
Nurse Educator 

Recent graduates and experienced professionals alike will find a wide 
variety of positions available which could provide the opponunity 
you've been loOking for. 
For those with an interest in specialization, challenges await in many 
areas such as: 

Neonatology Nursing 

Intensive Care 
(General & Neurosurgical) 
Cardio- Thoracic Surgery 
Burn Unit 

Inservice Education 

Coronary Care Unit 
Renal Dialysis & Transplantation 

If you are a Nurse considering a move please submit resume to: 
Mrs. J. MacPhaU 
Employee Relations 
Vancouver General Hospital 
855 West IZth Avenue 
Vancouver, B.C. V5Z IM9 


University of 
Alberta Hospital 

Edmonton, Alberta 





Sciences Centre 
Intensive Care Nursing 
.Myocardial Infarction 
. . Neurological 
· Arrhythmias Dysfunction 
. Renal Failure . Trauma 
· Respiratory Failure . Shock 


. 1 Ft ./.... 








.Nursing care of critically ill 
-Resuscitative measures 
-Use of monitoring and other advanced equipment 
-Multidisciplinary approach 
-Planned orientation 
-Supervised clinical experience 
-Continuing education program 
.Concentrated study and hard work 


Course Co-ordinator 
Intensive Care Nursing 
Health Sciences Centre GH601 
700 William Avenue 
Winnipeg, Manitoba R3E OZ3 

The Canedl8n Nur 

Dalhousie University 
School of Nursing 
Halifax, Nova Scotia, Canada 

Faculty Positions 

Available July 1, 1980 

Graduate Programme 
Doctorate in Nursing and experience in practice, teaching. 
and research a requirement. Clinical expenise in care of 
adults (medical/surgical) a necessity. 

Undergraduate Programmes 
Conceptually based curriculum for basic and registered nurse 


Positions available for faculty with experience in: 
a) community health nursing 
b) maternal-child care nursing 
c) fundamentals of health and basic nursing 
d) community and mental health nursing 

Qualifications: Masters in Nursing a requirement. Doctorate 
degree desirable. Salary and academic rank will depend on 
qualification and experience. These positions are subject to 
budgetary approval. 

Applicants should send curriculum vitae. and names of three 
referees to: 

targaret L. Bradle
Acting Director 
School of :'\Iursing 
Dalhousie UnÎ\ersity 
Halifax, :'IIo
a Scotia 
B3H 3J5 



Applications are invited from nurses with 
doctoral or master's degrees for the following 
j) Chairman of the Baccalaureate Degree 
Programme with experience in pro- 
gramme planning, curriculum develop- 
ment and team leadership 

ii) Faculty positions for nurses with ad- 
vanced clinical preparation in: 
- medical-surgical nursing 
- mental health-psychiatric nursing 
- parent-child nursing 
- community health nursing 
A Master of Nursing Degree programme is at an 
advanced planning stage. 

Salary and rank will be commensurate with 
education and experience. Applications with a 
curriculum vitae and the names and addresses 
of three referees should be sent to Dr. Margaret 
Scott Wright, Dean, Faculty of 
Nursing, The University of Cal- 
gary, 2920 - 24th Aveo N.W., 
Calgary, Alberta, T2N 1N4. 


1_"II.ru'tO"" .'7 

Canadian Lung Association 
Nursing Fellowship 

The Canadian Lung Association offers 
Nursing Fellowship awards up to the 
amount of $H.500.00 per year for 
Masters' or Post Masters' study in the 
pecialty of pulmonary nursing al 
an approved University. 

Completed applicalions must be received 
by February 8th to be eligible for the 
19HO-81 allocation. 

For further information and application 
form please write 10: 

The Canadian Lung Association 
75 Albert Street 
Suite 908 
Ottawa, Ontario 
KIP 5E7 

The Grande Prairie Hospital 
Complex is recruiting full-time 
and casual nurses. 

Current vacancies are in 
Out-Patients, Intensive Care. 
Medical, and Auxiliary 0 

Anticipated vacancies in other 
Apply to: 
Personnel Director 
Grande Prairie Hospital 
10409 - 98 Street 
Grande Prairie, Alberta 
T8V 2E8 
Telephone: 532-7711. 
Extension 78 

Foothills Hospital, Calgary, 
AI berta 

Advanced N eurological- 
Neurosurgical Nursing for 
Graduate Nurses 

A five month clinical and academic 
program offered by The Department of 
Nursing Service and The Division of 
Neurosurgery (Department of Surgery) 

Beginning: March, September 

Limited to 8 participants 
Applications now being accepted 

For further information, please write to: 
Co-ordinator of In-service Education 
FoothlUs Hospital 
1403 29 St. N. W. Calgary, Alberta 
TlN 21'9 

.. January 1

University of Ottawa 
School of Nursing 
Posilions available forthe 1980-81 
academic year in: 

Maternal and Child Nursing 
Psychiatric Nursing 
Docturate or Master's degree in 
clinical specialty and teaching 
experience required. Preference will 
be given to bilingual candidates 
(French and English). Salary 
commensurate with preparation. 
Send curriculum vitae and 
references as soon as possihle to: 
The Director 
School of Nursing 
Facultv of HeaIth Sciences 
t:niversitv of Ottawa 
770 King"Edward Avenue 
Ottawa, Ontario KIN 6

University Faculty 

Applications are invited for clinical faculty 
positions in an integrated baccalaureate 
program. Subject to budgetary approval, 
positions will probably be available for the 
I 98(}"8 I academic year in the fields of 
community, long term care. maternal-child and 
Psychiatric nursing. Candidates should have at 
least a Master's degree, demonstrated clinical 
proficiency. teaching and scholarly 
capabilities. Eligibility for registration with the 
College of Nurses of Ontario is essential. 
Candidates of both sexes are equally 
encouraged to apply. 
Salary and rank are negotiable and 
commensurate with qualifications and 
professional achievement. 
Interested persons should send a full resume 
and the names ofthree professional referees to: 
A. J. Baumgart, Dean 
School of Nursing 
Queen's lJni\ersit) 
Kingston. Ontario K7L 3N6 
Closing date ofapplications: April I. 1980. 

Prince George 
Regional Hospital 

Positions available for experienced nurses or 
nurses interested in developing their skills in 
specialty nursing -Operating Room, 
ICU/CCU, Neonatology Nursing. Must be 
eligible for B.C. Registration. 

. Well developed onentation program 
e Inservice Education 
. Expanding Operating Room and Obstetncal 

Prince George Regional Hospital is a 340 bed 
acute regional referral hospital with a 75 bed 
extended care unit and has a planned program 
of expansion. 

For funher information contact the: 
PU80nnel Department 
PrInce George Regional Hospital 
2000 -15th Annue 
PrInce George, British Columhla 
V2M IS2 

Th_ ,...."....I.n N..... 

McMaster University 
Educational Program 
urses In 
Primary Care 
McMaster Univer,ity School ofNur
ing in conjunction with the School of 
I\ledicine. offers a program for regis- 
tered nUrse
 employed in primary 
ettings who are willing to 
assume a redefined role in the primary 
health care delivery team. 

Requirements Current Canadian Regist- 
ration" Preceptorship from a medical 
practitioner. At least one year of work 
experience. preferably in primary care. 
For further information write to: 
'lona Callin, Director 
Educational Program for 'IIurses 
in Primary Care 
.'acult) of Health Sciences 
I\lc'\laster Universit) 
Hamilton. Ontario L8S 4J9 

Psychiatric Nursing 
Post Diploma Program For 
Registered Nurses 
This 16 week full-time program combines 
clinical experience with studies in 
comparative theories of Personality 
Development. Predisposingl 
Precipitating Factors. Crisis Theories, 
Nursing Process, Therapeutic Modalities 
such as Counselling and Group work, 
Outreach programs, Community 
psychiatry and Professional 
Winter program begins February 4, 1980 
Fall program begins September 2, 1980. 
For further information contact: 
Michelle Nichols 
Department Head 
Health Sciences Division 
Durham College 
P.Oo Box 385 
Oshawa, Ontario LIH 7L7 

Director of Nursing 
Applications are invited for the above 
position in a 45-bed general hospital 
located in the Saint John River Valley, 90 
miles northwest of Fredericton, New 
The successful applicant will be 
responsible for planning, organization, 
and adminislration of the hospital's 
nursing service. 
Qualifications: Candidates should 
preferrably possess a B.Sc.N. but 
equivalent combination of nursing 
administration education and experience 
will be considered. 
Apply with complete resume to: 
D. F. Maciver 
Northern Carleton Hospital 
P. 00 Box 95 
Bath, New Brunswick EOj IEO 

Head Nurse - Medical Nursing 
Vancouver General Hospital 

Applications are invited for the above position. The 

uccessful candidate wiJI be responsible for providing 
innovative and creative leadership in the development of 
clinical practice within the unit by teaching, consulting and 
demonstrating specialized nursing skills. She/He is 
responsible for the quaJity of nursing care and the nursing 
administration ofthe unit. 

The incumbent must be eligible for registration in B.C. and 
have experience in the specific clinical field, hold a BSN or 
equivalent post basic education. This person must 
demonstrate skill in leadership and interpersonal relations. 

Salary and benefits in accordance with the RNABC contract 

Please submit resume to: 

Mrs. J. MacPhail 
Employee Relations Department 
Vancouver General Department 
855 W. 12th Avenue 
Vancouver, B.C. 
V5Z IM9 

.>I f " ..:, 
j-:'. 'iL" 


Government of 
Newfoundland & Labrador 

Public NGtice 

Cottage Hospital Nurse l's 

Applications are invited for appointment on a pennanent or 
short term basis to the Nursing Staff of the Cottage Hospitals 

Bonne Bay 

Harbour Breton 

Salary for Cottage Hospital Nurse I, annual, sick leave, 
statutory holidays and other fringe benefits in accordance 
with Nurses Collective Agreement. 

Living-in accommodations available at reasonable rates, also 
laundry services provided. 

Applications should be addressed to: 

DIrector of Nursing 
Cottage Hospitals DIvision 
Department of Health 
Confederation Building 
St. John's, Newfoundland 
AIC 51ì 

Lome A KlIppert, M.D. 
Deputy Mi lister 

....... \ 
.. . 

',' - 
III .. 

\ - 

., \, c_
can go a long way 
. . ,to the Canadian North in fact! 
Canada's Indian and Eskimo peoples in the North 
need your help. Particularly if you are a Community 
Health Nurse (with public health preparation) who 
can carry more than the usual burden of responsi- 
bility. Hospital Nurses are needed too... there are 
never enough to go around. 
And challenge isn't all you'll get either - because 
there are educational opportunities such as in- 
service training and some financial support for 
educational studies. 
For further information on Nursing opportunities in 
Canada's Northern Health Service, please write to: 

I Medical Service. Ørench I 
Dep.rtment of N.tlon.1 H..lth .nd WeIf.,.. 
OttBw.,Ont.rio K1A OL3 
I Name I 
I Address I 
I City Provo I 
I .. Heallh and Wellenl Sant. el Bien-lIre social I 
Canada Canada 

The C.nedlen Nur.. 

Jen...ry 1.80 .. 



Index to 
January 1980 


The Faculty of Nursing, University 
of Toronto is offering the 
following courses in early 1980; 
Anatomy and Physiology: The 
Cardiac System. Wednesday 
evening, January 16-30. 
Anatomy and Physiology: The 
Nervous System, Thursday 
evening, January 17-31. 
Group Dynamics and Group 
Process, Monday evening, 
January 28-March 27. 
Anatomy and Physiology: The 
Respiratory System and Acid 
Base Balance, Thursday evening, 
February 7-28. 
Anatomy and Physiology: The 
Renal System and Fluids and 
Electrolytes, Thursday evening, 
March 6-27. 
Health Assessment Week, 
February 18-22. 
Quality Assurance: The Use of 
the Nursing Audit. March 6-7, 
Contact: Mrs. Dorothy Miles, 
Continuing Education 
Programme, Faculty of Nursing, 
UnÍ\'ersity of Toronto, 50 St. 
George St., Toronto. Ontario, 
M5S 1A1. 

Two 16-week post-DIploma 
Certificate Programs in Psychiatric 
nursing are being offered by 
Durham College and Whitby 
Psychiatric Hospital February 4 
to May 23, 1980 and September 2 
10 December 19,1980. For more 
information on this full time day 
course contact: Durham College 
of Applied A rts and Technology, 
Registrar'sDepartment. P.O. 
Box 385. Oshawa, Ontario, 
LlH 7L7. telephone 576-0210, 
ext. 342. 

Nursing Care of the Sick Newborn, 
current concepts of neonatal care; 
a five day program, a choice of: 
February II-IS, April 14-18 or 
June 9-13. Contact: B. Cragg. 
Co-ordinator, Nursing Education, 
The Hospital for Sick Children, 
555 UnÍ\'ersity A
'enue. Toronto, 
Ontario, M5G 1X8. 


The Nurses Practitioners 
Association of Ontario will be 
holding a workshop "Challenge of 
the '80's", March 27 and 28 at the 
Holiday Inn, downtown Toronto. 
Contact: Trudie Tumber. 1132 
Hm'endale Bh'd.. Burlington, 
Ontario, L7P 3E3, telephone 
845-9430, ext. 254. 

Therapeutic Compliance, 
Generalization and Maintenance is 
the topic of the Twelfth Banff 
I ntemational Conference on 
Behavioral Medicine to be held 
March 16-20, 1980, Banff, 
Alberta. Contact: Park 
Dm'idson. Department of 
Psychology, Uni
'ersity of British 
Columbia. Vancouver. B.C.. 
V6T IW5. 

The Third Annual Symposium on 
Patient Education organized by 
The Johns Hopkins University 
School of Hygiene and Public 
Health, will be held March 26-30, 
1980. Contact: han Barofsky. 
Hampton House 654, The Johns 
Hopkins UnÍ\'ersity, School of 
Hygiene and Public Health, 
Baltimore, Maryland. 

Looking Ahead 

"Interdisciplinary Approaches to 
Mental Health" will be the theme 
of the 57th annual meeting of the 
American Orthopsychiatric 
Association to be held April 7-11, 
at the Sheraton Centre Hotel, 
Toronto. Contact: American 
Orthopsychiatric Association. 
1775 Broadway, New York. N.Y. 

The fifth Annual Congress of the 
Oncology Nursing Society will be 
held May 28-30 at the Sheraton 
Harbor I sland Hotel in San Diego, 
CA 92101. Contact: Nancy 
Berkowitz. Oncology Nursing 
Society. 701 Washington Rd., 
Pittsburgh, PA 15228. 

Perspectives in Psychiatric 
Care '80, first national 
psychlatric/mental health nursing 
conference, to be held at the 
Fairmont Hotel, Wakefield, MA, 
May 28-31,1980. Contact: Carol 
Forsythe, Nurse Educator, 12 
Lakeside Park, Wakefield. MA 

The fifth Canadian Summer 
Workshop in Electrocardiography 
sponsored by the Rogers Heart 
Foundation will be held May3-6 at 
the Hotel MacDonald, Edmonton, 
Alberta. Contact: Anne S. Criss, 
ExecutÍ\'e Coordinator, Rogers 
Heart Foundation. 601 12th St. 
N., St. Petersburg. FL33705. 

All graduates of Highland View 
Hospital, Amherst, Nova Scotia 
are invited to attend a reunion 
tentatively planned for July I I to 
13. All interested in attending are 
asked to contact: The Reunion 
Committee, cl048 Regent St., 
Amherst, Nova Scotia, B4H 3TI. 

The Canadian Lung Association 
The Canadian N urse's Cap Reg'd 
F .A. Davis Company 
Designer's Choice (A Division of 
White Sister Uniform Inc.) 
Encyclopaedia Britannica Publications Limited 
Equity Medical Supply Company 
Glaxo Laboratories 
Frank W. Horner Limited 
J.B. Lippincott Company of Canada Limited 
Mont Sutton 


TheC.V. Mosby Company Limited 
Parke, Davis & Company Limited 
Pharmacia (Canada) Limited 
W.B. Saunders Company 
Schering Canada Inc. 

18, 19 

Smith & Nephew Inc. 4 
Toronto General Hospital 51 
Upjohn Health Care Services 8 
Wellcome Medical Division 
(Burroughs Wellcome Inc.) II 
Western Australian Institute of Technology 14 

Advertising Representatives 

Advertising Manager 

Jean Malboeuf 
60 I, Côte Vertu 
St-Laurent, Québec H4L IX8 
Téléphone: (514) 748-6561 

Gerry Kavanaugh 
The Canadian Nurse 
50 The Driveway 
Ottawa. Ontario K2P I E2 
Telephone: (613) 237-2133 

Gordon Tiffin 
190 Main Street 
Unionville. Ontario UR 2G9 
Telephone: (416) 297-2030 

Richard P. Wilson 
219 East Lancaster Avenue 
Ardmore, Penna. 19003 
Telephone: (215) 649-1497 

Member of Canadian 
Circulations Audit Board Inc 


01 .A 5mQ] 
1M '(tuq

70 J.nu.ry 1980 

The C.n.dlen Nuree 

· e · risan 
c s the cost of decubitus care 

. Î ntrolling 
infection fast 
Debrisan sucks bacteria and tox. 
ins out of decubitus ulcers. The 
ulcer is quickly cleansed, healthy 
granulation appears, and healing 
can begin. 
These (wet, exudative ulcers) 
averaged two days to clear the 
superficial infection and five days 
from the onset of therapy to ap- 
pearance of good granulation 
tissue in the ulcer base."1 





Day 0 Infected, heavily Day 2 Exudate diminished. Day 14 Clear, healthy 
exudating decubitus ulcer on Erythema and edema granulation base; grafted 
left hip. reduced. successfully. 




by relieving 
pain and 
ooour fast 



Day 0 Infected exudating Day 4 Clear, healthy 
decubitus ulcer on knee. granulation base. 

Day 14 Ulcer healing alter 
Debrisan discontinued. 

All patients in whom rest pain was 
present at the start of treatment 
noticed almost immediate relief of 
 rest pain when Debrisan was 
applied to the wound."2 
Debrisan was commenced and the 
following day, the smell had disap- 

Day 0 Undermined sacral Day 1 Surgically debrided 
decubitus ulcer infected with before Debrisan therapy and 
Pseudomonas and E.coli. alter 1 days, infection 
by saving valuable nursing time 
Only one Debrisan change a day. 
is needed. Debrisan therapy can " 
be stopped as soon as all signs of 
infection have gone and the ulcer 
is clean and granulated. 
Debrisan appears to be, in my 
opinion, just what we as nurses 
are seeklng."4 

Day 28 Appearance on 



OT_, If exudllllon I. "" .....,. 

Alter removing crust or 
necrotic tissue, pour a thick 
(4 mm) layer of Debrisan on 
the ulcer. 

Cover with a dressing. 

When the beacis are 
saturated (12 to 24 hours 
later) rinse and wipe them 
away. Apply a fresh layer of 

Debrisan- cleans 
decubitus ulcers fast. 

. : nn, cia (Canada) Ltd. 
'0 aJ, uébec 

1 Um\.T... 
8ewIck M, 
, U.llil 
MQdo,S I'" 

, ; - rgan JJ, AngIology 29:9, Sept 1878 
. A, Clin Trillie J 15:4, 1878 
, 32!e, June 1878 
Care A New Approach: 
, Illy, on HIe.t PM_Ie CC...., Lid. 

- Reg. T.M. 

A traditional family appro. 
to cold rehef. 



\, " 








For over a quarter of a century 
Coricidin has been a tradition. 
approach to relieving cold 
symptoms... with Canadian 
nurses and families alike. 
Coricidin. a combination of a 
trusted analgesic, antihistami 
and an effective decongestant 
Coricidin '0'*), offers a produ , 
form fQ}' virtually every age gr 
Pediatric drops are availablet 
children two years and over; 
chewable Medilets* for childr 
up to the age of 12; and Coric', 
and Coricidin '0' for teenage .; 
and adults. 
We would like to tell you what 
we've learned about colds. It - 
in a comprehensive 20 page b 
let compiled specially for nur 
H C Id " ,'j 
" ow to nurse a 0 answ
most of the questions you fa 
every day: · 
- What e1(actly is a cold. 
- Do children get more ctÞ 
than adults? 
- Are some serious dise"
easily confused witl] t
common cold? 
Send for your free copy of:'H I 
Nurse a Cold" 

Full information IS published in thè Çornp 
of Pharmaceuticals and specialtie$ f d a 
on request trom Schering Canada I,n . POI 
Claire, Quebec H9R I B4 
.REG.1M CJ c::J, 

. I 






Bulk En nombr. 
,twrd ft'OlSf.m J 
c.... c..sse 
. Hypothermia-the silent killer 
. Radiation enteritis, a race 
against time 
. A holistic approach enhances 
chemotherapy treatment 
. The syndrome of Inappropriate 
antidiuretic hormone secretion 
. Biofeedback, does It work? 






: 261980 

Royale Dobbi - a beautiful 1 00% t- tured DACRON
So light, so luxorious, so feminine. An elegant addition to your Spring 
wardrobe. Another exclusive fa. i from "CAREER DRESS". 






,1... _ 

.. .. 



Style No. 4785 - Pant Suit 
Sizes: 8-16 
100% textured DACRON' Polyester 
White, Blue. 

Style N. 44725 - Dress 
SIZes: 5- 5 
100% te ured DACRON 
Polyest' woven White, Blue. 




, , 
, "

ivision of 
Whi - her Unifor 


.:. . ..- 

- _. .. . - . - II - . a. - 

.11 _ I 



Anne Besharah 

Assistant Editors 
Judith Banning 
Jane Bock 

Production Assistant 
Gita Dean 

Circulation Manager 
PJerrette Hotte 

Advertising Manager 
Gerry Kavanaugh 

LNA Executhe Director 
Helen K. Mussallem 

Editorial Advbors 

Mathilde Bazinet, chairman. Health 
Sciences Department, Canadore 
College, Nonh Bay. Ontario. 

Dorothy Miller, public relations 
officer. Registered Nurses Associatio'1 
of Nova Scotia. 

Jerry Miller, director of 
communicatIOn sen'ices. Registered 
Nurses Association of British 

Jean Passmore. editor, SRNA news 
bulletin, Registered Nurses 
Association of Saskatchewan. 

Peter Smith. director of publications. 
National Gall
ry of Canada. 

Florita Vialle-Soubranne, consultant, 
professional inspection divisIOn. Order 
of Nurses of Quebec. 

Subscription Rates: Canada: one year, 
SIO.OO: two years, SI8.00. Foreign: 
one year, SI2.00; two years, $22.00. 
Single copies: SI.50each. Make 
cheques or money orders payable to 
the Canadian Nurses Association. 

Change of Address: Notice should be 
given in advance. Include previous 
address as well as new, along with 
registnltion number, in a 
provincial/territorial nurses 
association where applicable. Not 
responsible for journals lost in mail due 
to errors in address 

Canadian Nurses Association, 50 The 
Driveway, Ottawa. Canada. K2P I E2. 

Is the solitary skier so 
strikingly silhouetted on this 
month's cover aware ofthe 
dangers of hypothennia? Does 
he know that hypothennia is 
an aII-to-often overloaded 
feature of our Canadian 
Winters? For that matter, 
what do you know about 
hypothennia? Our special 
feature begins on page 23 of 
this issue. (Cover photo 
courtesy ofNFB Photothèque 


February 1980 Volume 76, Number 2 
The official journal of the Canadian Nurses Association 
published in French and English editions eleven times per 

, . 









HypothermJ............... .13 

PIorI_1e .................34 

RadIatIoa ealerltle .........38 

The extension of hospital I1abiIit} : a You're in hospital "ith "hat? 
IandmaR decision in the making 'Waureen Steen 
Corinne Sklar 
19 Successful chemotherap} 36 Day 
: th
 selective alternative for 
Diana C. Law psorIasIs patIents 
Margaret Burns and Dr. R.K. 
23 HYfOTHER1\UA -:- A Special Feature 38 A race against time: caring for a patient 
Taking the bite out of winter with radiation enteritis 
Roberta Ronayne 
24 ControUed hypothermia: A treatment for 41 Antidiuretic Hormone and its 
an acute anoxic incident Inappropriate Secretion 
Margot Thomas Muriel Burry and Lydia Martens 
28 Accidental hypothermia: Emergency 44 Biofeedback - does it "ork? 
rewarming techniques ChTlstie M. Burdis 
Donna Rae 
31 How not to be a victim 
Judith Banning 
13 Input 49 COME TO THE COAST 62 Calendar 
It's IheCNA in B.C.- 
16 a pot poum for you to see 

The Canadian Nurse welcomes suggestions for anicles 
or unsolicited manuscnpts. Authors may submit 
finished articles or a summary of the proposed 
content. Manuscripts should be typed double-spaced. 
Send original and carbon. AU an.cles must be 
submitted for the exclusive use of The Canadian 
Nurse. A biognlphical statement and return addre., 
should accompany all manuscripts. 

ISSN 0008-4581 

Indexed in International Nursing Index. Cumulative 
Index to Nursing Litenlture. Abstnlcts of Hospital 
Management Studies. Hospital Litenlture Index. 
Hospital Abstnlcts, Index Medicus, Canadian 
Periodical Index. The Canadian Nurse is available in 
microform from Xerox University Microfdms. Ann 
Arbor. Michigan 48106. 

The views expres
ed In the anicles are those of the 
authors and do not necessarily represent the policies of 
the Canadian Nurses Association. 

@Canadian Nurses Association. 1980. 






1 T 





-I - :II:;;: --- --- 
-=- ;,. 
"---- --- 
:J. -- 

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w. Mm.....WIvJi@ 
"- E- 
---,J '
. ''\ 

THE CLINIC SHOEMAKERS · Dept CN-2, 7912 BonhommeAve. . St. Louis, Mo. 63105 

"Good nursing saves lives." 
There it is, in a nutshell. But 
what, exactly, is good 
nursing? Certainly there's 
more involved than simply 
knowing what has to be done 
and following correct 
"Good" nursing is good 
from three points of view: it 
affords satisfaction to the 
nurse as a practitioner of her 
profession, to the patient as 
the recipient of her care and to 
the family of the patient 
whose Care they have 
relinquished to that nurse. 
It was this triangular 
relationship between nurse, 
patient and family that Laura 
Barry, the author of next 
month's feature article on 
GuiIlain-Barré Syndrome, set 
out to investigate. The article 
is based on work she carried 
out in order to meet the 
requirements of a post basic 
program in neurological and 
neurosurgical nursing she was 
enrolled in at the time. 

Warchfor and read' 'The 
Gui/lain-Barré Syndrome", in 
your March issue of The 
Canadian Nurse. 

The comment that "Good 
nursing saves lives" was 
made by the father of the 
patient, Linda, whose illness 
and subsequent 
hospitalization provided 
material for her study. When 
Laura set out to write her 
paper she decided that the 
aspect of Linda's case that 
interested her most was the 
dynamics of the relationship 
that existed between the 
patient Linda, Linda's family 
and the nurses who cared for 
her. So she wrote to all of 
them. explaining her project 
and asking for their 
interpretation of what had 
happened during the three 
weeks that Linda was in 
When she wrote to her 
colleagues this is what she 
said: "I would like you to 
think back to the time when 
Linda was a patient. As I 
recall, the 
nurse-patient -family 
relationship did become quite 


strained at times... Why did 
things deteriorate between 
Linda and ourselves, as well 
as her parents? There were 
times when the relationship 
was good. Why wa... that? 
How did we make things 
better? What did we do that 
made things worse?" 
Establishing a caring 
relationship with a patient is 
never easy. One of the nurses 
Laura talked to during her 
project listed some of the 
problems she had recognized 
in caring for Linda: 
. inability to understand 
what the patient is trying to 
. inability to alleviate a 
patient's fears 
. difficulty in making a 
patient physically comfortable 
· knowing that the patient 
depends on you for survival 
. helping the patient to 
develop confidence in other 
staff members. 
All of the nurses she 
interviewed recognized the 
need for peer support, and the 
benefits to be gained from 
nursing conferences: "By 
talking with their peers, 
nurses come to realize that it 
is alright to get angry and 
frustrated at times. They 
realize they need not feel 
guilty about these 
feelings...Nurses are human 
and everyone has bad days. It 
is comforting to know that you 
are not alone. A nursing 
conference can give a nurse 
the encouragement she needs 
to go out and try one more 
time. .. 
Linda's comment on her 
perception of the 
nurse-patient relationship is 
instructive: "The most 
important thing to remember 
is that you are dealing with a 
human being, not a patient. A 
human being has 
moods... sometimes 
everything is okay and you are 
in a good mood but sometimes 
things will make you 
depressed or frustrated and 
therefore nurses should be 
able to pick up on vibrations 
and react accordingly. " 
Good nurses, as we all 
know by now, are good 

communicators. Linda says: 
"Talking to the patient like a 
person is a thing some of the 
nurses did but not all. To feel 
a part of the world, you need 
to know what is happening in 
the news and life in general. A 
patient needs to feel a part of 
the outside world." 
When a family abandons 
one of its members to the 
ministrations of hospital staff, 
they do so with mixed 
feelings. Gertrud Ujhely put it 
this way: "Those who 
assumed quite a bit of 
responsibility before for their 
relatives who are now ill. as a 
wife would for her husband or 
a mother for her child, are 
liable to feel especially 
helpless now that the nurse 
has taken over so exclusively 
and efficiently.. .They fight 
down their tears, which are a 
mixture of concern about the 
outcome of the illness, their 
own helplessness and their 
rage against the efficient 
machine in white who has 
taken over as if the patient had 
always belonged to her-as if 
they, the relatives, had never 
played any role in the 
patient's life." 
Good nursing involves 
recognition of the contribution 
that the family can make. As 
Linda commented: "My 
family played a very big part 
in my time in hospital and, if 
the family is willing, I think 
they should be included in 
most aspects of the 
hospitalization. " 
It also involves 
recognition of the nurse's role 
as leader in this triangle of 
nurse-family-patient. Linda's 
father had this to say:"1t was 
the nurses that helped her and 
liS keep up our spirits. They 
were calm and always 
optimistic. They had humor 
and sympathy. They gave out 
courage and hope. They 
exuded confidence and faith." 
Listen to Linda's father 
again: "Good nursing saves 
lives. The non-medical aspect 
is enlisting all the help you can 
get from the patient, the 
family and friends and then 
with you (the nurse) as the 
focal point. willing the patient 

Th_ ,...___.,.1...._ ............ 

to live with all the strength 
that you can muster...AII 
Linda's nurses in Intensive 
Care did just that: they 
cared-intensively." '\I.A.B. 






· i- 

St:venty-five years ago next 
month, in March 1905, Vol. J, 
No. lof TheCanadianNurse 
rolled off the press and into 
the eager hands of the small 
group of graduate nurses 
responsible for its 
appearance. "Devoted to the 
interests ofthe nursing 
profession in Canada, and to 
the protection of the public," 
its founders were staunch 
advocates oflegislation 
enabling properly qualified 
nurses to be registered by law 
Most ofthem were 
graduates of Toronto General 
Hospital School ofNursmg. 
The decision to undertake 
publication of a journal for 
nurses had been taken at a 
meeting oftheir Alumnae 
Association three months 
earlier: members approved by 
a standing vote a resol ution 
that: "We undertake the 
Journal, placing our pin on the 
cover, and that while keeping 
the management in our own 
hands we make the other 
Alumnae Associations feel 
they are welcome to work 
with us." 
Within six months. the 
business manager was able to 
report that the venture was an 
"undoubted success" and 
plans were already underway 
to enlarge the quarterly to "a 
Dominionjournal, produced 
monthly" . 
In March, as part of its 
anniversary celebrations, CNJ 
takes a look at those early 
journals, as well as a look 
ahead to the year 2000. 

ntr · ducing New 
they stay twice 


Why It's Better 
for Baby 

-"= J; If 



I Softer surface next to 
. baby's skin 
o Embossed topsheet looks 
and feels softer reduces 
skin contact and mcreases 
separation of skm from 
moisture in pad 



2 A drier, more 
. comfortable baby 
o Polyester hbre topsheet is 
more hydrophobIc _ does 
not absorb fluids itself but 
encourages passage 
through mto absorbent 
padding below resists 
o Stronger absorbent pad 
with stronger tissue enve- 
lope. _ provides 225 percent 
more wet strength for a 
60 percent reduction in 
tearing and shredding. 

Proof Positive That Quilted Pampers 
Stay Twice as Dryas Cloth 




Cloth Pampers 

Equal amounts of 
water are placed on 
each dIaper 

A blotter IS placPd 
over each wpttf'd 

A weJght IS placed on 
each blotter 

Qwlted Pampers IS 
tWIce as dryas cloth 

I uilled · am · e s- 
as dryas cl.1 


It's Better 
for Nurse 
and Better 
for Mother 

A. ... 


, Saves time and 
The superior contaIn- 
ment of New QuIlted 
Pampers versus cloth 
benehts both nur."
s and 
mothers with 
o Fewer changes of 
bed lInen and 
baby's clothIng 
o More time for 
other important 
tasks for nurses, 
more playtime 
Wlth baby for 


Easier than cloth to 
fit and change 
A one-piece system- 
more convenient than 
cloth to change and clean 
up - easy to fit with tape 
not pins 








III.,. . 

used more often than cloth 
in hospital nurseries 





The extension of hospital liability: 
a landmark decision in the making 1 

Corinne Sklar 




In caring for her comatose patient, a 
nurse detected a fruity odor on her 
patient's breath and alerted the 
physician. The diagnosis at this time of 
diabetes as the cause of the patient's 
coma came too late for the patient. In his 
d.ecision the trial judge found that the 
damage caused to this patient was the 
result of the negligence of the internist, 
an endocrinologist: he also found that the 
hospital was legally liable for the 
negligence of this physician. 
This decision is important because, 
in holding the hospital responsible, the 
trial judge extended the liability of 
Ontario public hospitals beyond previous 
limits: the physician in this case was not 
an employee paid by the hospital. He 
was a member of the medical staff and 
was an "independent contractor" billing 
patients either directly or, more 
common1y, through the provincial 
medical insurance plan. Previously, 
physicians in this position did not fall 
within the area of the hospital's legal 
responsibility for negligence. Instead, 
the physician was legally responsible to 
the patient directly. However, the 
patient and his family did not sue this 
physician as a separate defendant. Under 
the law as it stood until this decision of 
Mr. Justice Holland, the hospital would 
not have been liable for this negligence 0 
lfthe limitation period for bringing a suit 
against the individual physician had 
expired, then the patient would have 
been unable to bring a law suit against 
this physician and receive financial 
redress from him. 
The case is presently under appeal 
to the Ontario Court of Appeal and at 
this writing had not yet been heardo 
Because of the important ramifications 
of this trial decision for hospitals, it is 
likely that the final detennination of this 
important legal decision will fall to the 
Supreme Court of Canada. 

[)irect hospital responsibility 
The liability of hospitals can arise either 
directly or vicariously, that is, through 
the act of another for whom the hospital 
is legally responsible. Direct 
responsibility may result where there is a 
failure of the hospital to fulfill its legal 

obligations (duties) to the patient. Such 
failure may result from either a breach of 
contract or negligence (i.e. tort) or a 
combination of these. The duty or 
obligation to the patient results from the 
relationship between the hospital and the 
patient and damages may be awarded to 
the patient from the hospital where the 
hospital has failed to fulfill its 
undertaking to the patient. The direct 
responsibility of a hospital exists alone 
and is not contingent upon the nature of 
the relationship between the hospital and 
the person whose conduct resulted in the 
patient's hann. Hospitals are required to 
provide as part of their undertaking such 
services as nursing services, bed, 
laundry and dietary services, control of 
infection, reasonable facilities and 
equipment for diagnosis, investigatibn 
and treatment. The latter may vary from 
hospital to hospital depending on the 
scope and function of the facility. 
Hospitals are legally required to 
exercise reasonable care in selecting 
competent staff members. For 
physicians, such responsibility is 
delegated to the medical Chief of Staff or 
the committee of physicians designated 
to perform this function. In Ontario, 
appointment to the hospital's medical 
staff is for one year at a time and may be 
renewed annually orthe privilege may be 
revoked. The supervision of the medical 
staff is in the hands of such committees 
as well as part of the supervisory and 
"quality control" function. Physicians 
may be characterized as full time 
hospital employees under a contract of 
service, part time consultants, or 
"independent contractors" attached to 
the active medical staff roster; other 
variations of physician-hospital 
relationship may exist. 

Vicarious responsibility 
Under the doctrine of" respondeat 
superior" (let the master answer), 
hospitals are vicariously liable for the 
conduct of their employees, servants and 
agents acting in the course of their 
employment. The primary element in 
fixing liability here is the natuTe of the 
relationship between the hospital and the 
employee (or individual whose conduct 

is in question) and not the relationship of 
the hospital and the complainant. The 
view is that the master/employer by 
virtue of his position is able to control 
both the type of work perfonned and its 
manner of perfonnance. 
Originally, hospitals were not held 
responsible for the negligence of 
professionals in the perfonnance of their 
professional responsibility; this liability 
has developed gradually over the past 
sixty years. In 1909,2 the prevailing 
judicial view was that a hospital was on1y 
legally responsible to its patients for due 
care in the selection of competent 
personnel. The hospital was not 
considered legally responsible for the 
negligence of physicians and nurses 
acting professionally in the course of 
delivering patient care. Thus, a 
dichotomy developed whereby hospitals 
were legally vicariously responsible for 
negligence in the perfonnance of 
"administrative" functions by 
professional employees such as nurses 
because such duties were part of the 
hospital's undertaking. However, there 
was no hospital responsibility if the task 
under consideration was perfonned in 
the exercise of" professional" skills 
because the master/hospital did not 
control the professional in such exercise. 
Such a view could not be sustained 
as the role and function of the hospital in 
the community grew more complex and 
diverse and as increased social 
responsibility and accountability were 
imposed 0 Over the years, the 
"administrative" versus" professional" 
dichotomy was discarded and hospitals 
became vicariously liable for the 
negligent acts of their professional 
employees acting in the scope of their 
employment: 3 nurses, interns, residents, 
anesthetists, radiographers, etc. 
However, within the expanding 
umbrella of hospital responsibility for its 
professional staff, some limiting aspects 
were retained - until Yepremiano The 
distinction continued to be drawn 
between the relationship of a hospital 
with a professional on a "contract of 
services" and a "contract for services" 0 
The fonner attracted the hospital's 
responsibility because the relationship 

was one of employment, ie. master and 
servant. The latter was excluded because 
the individual was an independent 
contractor and outside of the hospital's 
control of the work and manner of its 
In 195 I,4 the English Court of 
Appeal brought the "contract for 
services" into the ambit of hospital 
liability holding that where a physician is 
employed and paid by a hospital, 
whether under a contract of service or 
for service, the hospital will be liable for 
his negligence. Thus. the nature of the 
relationship between the hospital and the 
professional is also considered in the 
context of the remuneration of the 
professional- ifthe patient selects and 
pays the professional, then the hospital 
may not be responsible. 
A Canadian decision illustrates this. 
In the case of Aynsley v. Toronto 
General Hospital, 5 the patient's brain 
damage was held to have been caused by 
the negligence of both the senior resident 
in anesthesiology and the privately 
employed anesthetist. The hospital was 
found responsible on1y for the negligence 
of the resident and therefore had to pay 
on1y for the percentage of fault 
apportioned to his conduct. The private 
anesthetist personally bore his 
apportioned cost of the negligence; he 
was directly legally responsible to the 
patient who had selected and employed 
him. The hospital was vicariously 
responsible for the negligence of the 
resident whom the hospital employed. 
The hospital was not responsible either 
directly or vicariously for the negligence 
of the private anesthetist. Similarly, a 
hospital is not responsible for the 
negligent acts ofthe private duty nurse 
who is selected and paid by the patient or 
his family. Hospitals are responsible for 
the negligence of their staff nurses in 
their delivery of patient care. 
Very often today, a patient may be 
admitted to hospital under the care of a 
physician who is not a hospital employee 
and who has not been specifically 
selected by the patient. This was the 
situation in Yepremian, as we shall see 

The facts 
The patient. Tony, was a 19-year-old 
apprentice body shop repairman who 
lived at home with his family. On 
October9, 1970, he returned home from 
work complaining of not feeling well. He 
was very weak and over the weekend his 
polydipsia and polyuria increasedo The 
family took him to see Dr. G., the 
physician covering the practice of their 
family physician who was away that 
holiday weekend. A diagnosis of 
tonsillitis was made and erythromycin 
prescribed. The physician's notes 
presented in evidence did not mention 
the excessive thirst and urination of the 
patient. The patient was too drowsy and 

ill to respond to questions. The family 
testified that the doctor had been 
informed of these symptoms. 
That evening. October 12. Tony, 
who had continued to vomit and to drink 
and urinate excessively, began to 
hyperventilate. Alarmed, his family 
rushed him to Scarborough General 
Hospital emergency, where he was 
admitted in a semi-comatose state. The 
family testified that again Tony's 
symptoms had been reported. When 
asked about drugs (the hospital received 
many cases of young people with drug 
overdoses at that time), the staff were 
shown the medication prescribed earlier 
Dr. C. was the general practitioner 
on duty in emergency that night. The 

"diagnosis" he recorded that night was 
the symptom "hyperventilation"" 
Phenobarbital and valium were 
administered. Tony was already 
Dr. R., the internist on call and a 
specialist in endocrinology, ordered 
Tony transferred to the LC. U. in the 
early morning hours of October 13. No 
urinalysis was yet done. The case report 
contains a partial summary from the 
medical record of the treatment and 
observations. 6 The normal saline LV. 
was changed to 5 per cent glucose at 4:00 
a.m. and a foley catheter was inserted. 
The patient was comatose. His 
potassium level was recorded at 5.5 at 
8:a.m., within normal limits. His vital 
signs during this period ranged as 

"When I was thirteen, I really wanted 
to be a nurse. Today I remembered why:' 

"Patient contact. That's 
what nursing meant to me 
all along. And that's what I get 
as an Upjohn HealthCare 
Services sM nurse. 

, t: 
t . .... ';) 

"I'm the kind of person 
who needs that special one- 
on-one relationship with a pa- 
tient. I also need some control 
over my work schedu Ie, for my 
family's sake. And I thrive on 
variety... it keeps me growi ng. 
"Working with Upjohn 
has turned out to be a different 
kind of nursing than I'd 
ever known. But it's the kind 
I always had in mind." 

HM6402-C@1979He..thC.",Ser;,ee.Up""'n, Ltd. 




Interested? Find out 
what others say about Upjohn 
HealthCare Services. Oppor- 
tunities in home care, hospital 
staffing and private duty. Of- 
fices in 14 communities across 
Canada. Write for our booklet 

___ SERVICES." _ 
- - 
r ". 

Please send me your 
free booklet "Nursing 
Opportunities at 
Upjohn HealthCare 




City Province Postal Code 
Mail to; Upjohn HealthCare Services 
Dept. A 
Suite 203 
716 Gordon Baker Road 
Willowdale, OntarioM2H 3B4 

follows: B.P. 138/80 - 102/60; Temp. 99.4 
-100.7; R. 40- 36. 
At 12:20 p.m. on October 13, the 
diagnosis of diabetes was made upon the 
nurse's report of her patient's fruity 
breath odor. A STAT urinalysis showed 
4+ sugar. The I. V. containing soda 
bicarbonate was discontinued and insulin 
was given Sf AT. 
The patient remained comatose or 
semi-comatose until he suffered a 
cardiac arrest about 12:55 a.m. on 
October 14. Severe permanent brain 
damage resulted. 

. The nurses and laboratory staff (and 
hence the hospital under the vicarious 
responsibility doctrine) 
. Dr.C. 
. Dr.R. 
. The hospital (for the negligence, if 
any, ofDrs. C. andR.) 

Apportioning the responsibility 
The trial judge considered the negligence 
and liability of the following: 7 
. Dr. G. (named as defendant) 

Dr. G. - Mr. Justice Hollahd found that 
Dr. G. had not met the standard of care 
required of the reasonable prudent 
medical practitioner and hence was 
negligent in failing to diagnose the 
diabetes of his patient. However, the 
cause of Tony's injuries was the cardiac 
arrest. Therefore, liability would be 
imposed on Dr. G. if his negligence 
caused or contributed to the cardiac 

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Phannacia (Canada) Ltd 
Dorval, Quebec 'Reg'dT 

Thejudge found that the intervening 
acts of negligence "insulated" Dr. G. 
from liability. Dr:. G. 's failure to 
diagnose the diabetes did not affect or 
contribute to the treatment Tony 
received at the hospital. He therefore 
dismissed the action against Dr. G. 

The nurses and hospital laboratory 
staff-The trial judge found that there 
was no negligence attributable to these 
hospital employees for which the 
hospital could be held vicariously liable. 
The laboratory staff was not 
responsible for the interval in processing 
ofroutinely ordered samples requested 
during the night shift. Such procedure 
was in accordance with accepted 
hospital standards. 
It was suggested that the nurses 
should have initiated a Sf AT urinalysis 
on the patient's admission to LC.U. 
Only a routine urinalysis was ordered. 
The trial judge found that the nurses 
complied with the prevailing hospital 
standards: such Sf AT orders were on1y 
done on doctor's orders. Hence, the 
hospital was relieved of vicarious 
liability here. 

Dr. C. - The trial judge found that Dr. 
C. was negligent in his assessment and 
treatment of Tony . However, as with Dr 
G.. the intervening negligence of Dr. R. 
in the handling of Tony's case insulated 
Dr. C. from legal liability. Dr. R. 's 
negligence was not foreseeable and Dr. 
C. 's diagnosis did not contribute to Dr. 
R. 's subsequent conduct of the case. 

Dr. R. - Because Dr. R. was an intemisl 
and specialist in endocrinology, a 
specialty in which the care and treatmenl 
of diabetes falls, he was held to a higher 
standard of care than would have been 
expected of a general practitioner. The 
trialjudge indicated that a serum 
potassium level below 3.5 creates a 
serious risk of cardiac arrhythmia 
leading to cardiac arrest. 8 The trial judge 
found Dr. R. negligent in failing to 
diagnose the diabetes earlier. He further 
found that Dr. R. ought to have been 
alert to the dangerto Tony's serum 
potassium level in ordering sodium 
bicarbonate to deal with Tony's acidosis 
(which lowers potassium levels) and ther 
ordering the insulin in response to the 
diagnosis of diabetes (insulin also lowers 
serum potassium). The record showed 
that Tony's potassium level was 5.4 at 
8:45 a.m. and by 2: 10 that day it had 
fallen to 1.5 and it remained below 3.5 
thereafter. Potassium replacement was 
begun at about 3:30 p.m. that day. In the 
view of Mr. Justice Holland, Dr. R. 
failed to effect proper management of 
Tony's treatment once the diagnosis of 
diabetes was made. thereby resulting in 
the cardiac arrest. 

.. ...It is mv view that Dr. R.'s negligence 
in his treatment ofT ony Yepremian was 
the cause of the cardiac arrest. If this 
young man had been properly treated 
after the diagnosis had been made, he 
would, in my opinion, have recovered 
without harm. I consider Dr. R.' s 
negligence to have been extreme and I 
have no doubt that he would have been 
held liable if sued.' '9 

The hospital's liability for the negligence 
ofDr.C. andDr.R. -Dr. R.'s 
negligence being the cause of the 
patient's damage, hospital liability for 
Dr. C. 's negligence was not considered 
The trial judge stated that 'The plaintiffs 
can sue whom they choose and I must be 
careful in deciding the issue of the 
liability of the hospital not to let myself 
be influenced by the result of the failure 
to sue Dr. R." .10 (Note: If the hospital 
had not beenfound legally responsible 
here. and if the limitation period for 
bringing a suit against Dr. R. had 
expired. then there would have been no 
one legally responsible to compensate 
the plaintiffs for their loss. If Dr. R. had 
been a named defendant then the 
following alternatives might have 
resulted: (a) Dr. R. solely liable and the 
hospital freed of liability or (b) both the 
hospital and Dr. R.liable and hospital 
liability extended as ultimately 

Your patient may enjoy 
being pregnant. But she 
certainly doesn't enjoy the 
constipation that often 
goes with it! She'll thank 
you for recommending a 
laxative that works slowly, 
gently and effectively. 
That's the Metamucil way 

. ,..,--...... 

 I- - ..-
 _, ' . 

Mr. Justice Holland, in finding the 
hospital legally responsible for the 
negligence of Dr. R., reviewed the 
relevant English, U. S. and Canadian 
case law and the relevant legislationo In 
his view, the following principles 
resulted, "excepr in exceptional 

I. a hospital is not responsible for 
negligence of a doctor not employed by 
the hospital when the doctor was 
personally retained by the patient; 
2. a hospital is liable for the negligence of 
a doctor employed by the hospital; 
3. where a doctor is not an employee of 
the hospital and is not personally 
retained by the patient, all of the 
circumstances must be considered in 
order to decide whether or not the 
hospital is under a non-delegable duty of 
care which imposes liability on the 
hospital. "II 
The instant case lies in the third 
category. The patient, his family, and the 
public-at-Iarge, in the trialjudge's view, 
looked to the hospital for a complete 
range of medical attention and treatment. 
The patient did not select the hospital 
and physicians in the usual manner. 
Here, the urgency of the situation 
dictated the "choice" of this hospital- 
it was the closest one. The decision 
refers to the expectation of the public: a 
high standard of care is anticipated from 

all, and especially from the physicians, 
"skilled medical attentioJ' and 
treatment. "\2 Similarly the admission to 
LC.U. resulted inTony's receiving care 
by the medical staffman on call at the 
time ("the luck of the draw" or rotation 
The trial judge found that the 
hospital had selected Dr. R. as a member 
of the hospital's specialist staffYThe 
hospital had a legal responsibility to 
admit the patient and underThe Public 
Hospitals Act (Ontario). 14 the hospital is 
directly responsible to the patients 
therein for the quality of care delivered. 
In the view of Mr. Justice Holland, both 
The Act and common sense underscore 
this obligation of a hospital and the 
hospital has the opportunity of 
controlling the quality of medical service 
delivered. 15 The trial judge concluded 
that in accepting the patient, the hospital 
undertook to him a duty of care that 
could not be delegated. 16 He awarded 
damages assessed at $390,262.11 and 
It is not clear from the decision whether 
the finding of hospital liability results 
from an extension of direct corporate 
responsibility or from vicarious 
responsibility. What does emerge is the 
position that hospitals have greater 
accountability to the public for medical 
treatment. (continued on page 48) 

Metamucil is made 
from (gluten-free) grain, 
providing fiber that 
produces soft, fully formed 
stools to promote regular 
bowel function. 

Available as a powder (low in 
sodlUm) and a lemon-lime flavoured 
Instant Mix (low in calories). 
Why not give your patients our 
helpful booklet about constipation? 

The laxative most recommended b ' Physicians. 



When a patient can't 
move around, gas can be 
a problem, and a painful 
one at that. So for pa- 
tients who are immobile 
following surgery or for 
patients, give them extra 
strength OVOL 80 mg, th
chewable antiflatulent 
tablets that work fast to 
relieve trapped gas and 

! . ' 1 80 
I ..Gas 





Pro uc-t Inonograph available on request. 

Manufactured 01 tin..' atH' A 
must ror.....!y nur... 
No. eaa. 3'11' 
No. 199. 4'11" 
No. 700, 5W' 
No. 702.7"- . 

Rligged and dependable. 10 . 





O ,.. 
.rror. HanGsome zippered ca.. 
to lit your pod".t. 
121." compl.... 
NURSES PENLIGHT. Powartul beam lor examination 01 
throat. alc. Durable alelnl....at..1 ca.. wit" pocke. 
clip Mad. In U.S.A. No. 28 16.11 comp1a'a with 
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Canadian nun... SUOJ at..' bobby pin. w/(h nylon 

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NURStS 4 COLOUR PEN '0' recording temp.rllture, 
blood pr..aur., atc. On.hand oparalion ..IKt. ...cI, 
black, blue or green. No. 32. '2.21 ..cPt. 




No 521 BLUE. No 523 GREY. All '5",u 


 (14 J. 12 .trlpe. p.r c.rd 


 B..uUfully de.lgned to .how 
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Out of sight. out of mind 
The October issue of 
CNJ, with its focus on 
maternal-child nursing, raised 
many important 
One critical aspect of the 
potential crisis in OB nursing 
which was not addressed in 
lhe issue is the depressing fact 
that the maternity 
(postpartum, nursery and 
antepartum) area continues to 
be a repository for nurses who 
are, for any number of 
reasons. unable to function in 
other areas. 
How often is the 
following statement included 
in an evaluation or transfer 
"Ms. X has had considerable 
difficulty in carrying out the 
nursing process on this busy 
medical (surgical, orthopedic, 
neuro, etc.) unit. She would 
benefit from the opportunity 
to develop her nursing 
potential in an area with an 
easier (lighter, less hectic, i.e. 
lower status and priority) 
pace. .. 
When Nurse X has shown 
her inability to function in any 
other area, she is sent to the 
OBS unit. (I suspect that 
geriatrics may suffer from the 
same problem.) Thus 
maternity units come to be 
staffed with an 
overabundance of nurses who 
"don't fit in" anywhere else 
and the talented and capable 
nurses in that area end up 
carrying the load. 
Head Nurses. reluctant to 
play the role of hatchet 
women, do not document 
these less than satisfactory 
nurses out of the area, but 
rather attempt to carryon, 
thus lowering the overall 
standard of nursing care on 
their units. 
We must look to 
education and inservice to 
develop the skills and 
knowledge necessary to 
improve the standard of 
nursing care in OBS nursing. 
We must also look at our 
image as a low status and low 
priority nursing area. As long 
as we are con'ent to be the 
"dumping grc und". it will be 
difficult to att,-act and keep 


nurses who are able and 
anxious to keep pace with the 
many changes and challenges 
affectingOBS nursing. 
-Frances M. Tufts, RN, BN, 
Don Mills. Ontario. 

Counseling today's teens 
Author Shirley Wheatley 
(guest editorial, November 
1979) suggests that "kids have 
the right to express their 
sexuality at any age". Is the 
role ofthe nurse to become 
that of social engineer for a 
society freed from morality 
and controlled by 
'profess ionals' ? 
More contraception, 
more abortion, more sex 
education will not solve any 
problems. They haven't in 
Denmark, Sweden or Britain. 
Self-appointed 'experts' 
have manipulated parents by 
using tenns such as 'family 
life', 'values education' and 
'responsible education' into 
thinking these courses will 
enhance responsible moral 
behavior. In fact, their basic 
philosophy is that there are no 
rights or wrongs, the family is 
dispensible and all lifestyles 
are equally valid. Parents who 
object are . archaic 
oppressors'. Much of 
education is intended to 
encourage youth to discredit 
their parents and put them at 
the mercy of peer pressure in 
rap sessions manipulated by 
these biased . professionals' . 
People today have lost 
thei r concept of righ t and 
wrong; they are operating in 
moral confusion. This is 
tragic. It is even worse when 
these same people have a 
missionary zeal to impose 
their confusion on others - 
through legislation, schools 
and through the health 
-John R. Caswell (student 
nurse) andGav White 
Caswell, Saskatoon, Sask. 

Information please 
I have heard that some 
hospitals in central Canada 
have day care facilities for 
children of their staff and I 
would like information 
regarding this. 

Where I am employed we 
have a severe nursing 
shortage and I'm sure if there 
were a day care center more 
nurses with young families 
would be able to return to the 
work force, part-time or 
For myself. the logistics 
of arranging care for a 
four-year-old and a 
16-month-old so that I can 
work part-time are 
Perhaps ifI had 
something concrete to put to 
my hospital, I could get 
approval to set up a facility. I 
have even heard that they 
make money! 
I look forward to hearing 
from colleagues. 
-Gwendolynne Kamnagh. 
RN, S.S. No.2, Kamloops. 
B.C., V2C 6C3. 

Strength in numbers 
One of my 
responsibilities as assistant 
director of nursing is the 

Quality Assurance Program. I 
would like to form an 
Association of Quality Care 
Coordinators to promote 
educational and research 
programs in the area of quality 
Could you publish this 
request in The Canadian 
Nurse? Interested 
respondents could write 
directly to me. 
-Brian R. Rogers, RN. BSc., 
St. Joseph' sGeneral 
Hospital. North Bay, Ontario, 
PIB 3L9. 
Did you know... 
Chloramphenicol and 
acetaminophen should not be 
used concurrently as the rate 
of elimination of 
chloramphenicol from the 
body is reduced almost five 
times by the presence of 
acetaminophen. Ifthis 
combination must be used, the 
dose of chloramphenicol 
should be reduced or serum 
chloramphenicol levels 
monitored closely. OW 

Students & Graduates 




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Being a nurse and an officer in the Canadian Forces offers 
many advantages. If you're a Canadian citizen and a graduate 
nurse (female or male) of a school of nursing accredited by 
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LIPPINCOTT- The Leader for over 100 years through it's 
publications to the Canadian Nurse. 

By the Nursing Development Conference Group. Edited by Dorothea E. Orem, R.N., M.S.N.Ed. 

The 2nd edition of Concept Formalization in Nursing: 
Process and Product reflects the progress made to date. 
This volume refines previous conclusions and moves on 
to descriptions of the individual or group dynamics 
associated with formulation, expression, and acceptance 
of nursing's conceptual structure. Orem's general theory 
of nursing is used to provide the conceptual framework 
for research and the structuring of nursing knowledge. 
Throughout the text, drawings, tables, charts, and graphs 

are used to illustrate key points. 
Because Concept Formalization in Nursing: Process 
and Product, 2nd Edition, represents the significant and 
continuous advance of nursing sciences, it will serve as 
an important reference for teachers and students of 
nursing, nurse practitioners, nursing administrators, and 
all who have an interest in nursing as a unique discipline. 
Little, Brown. 313 Pages. Illustrated. 1979. $15.50. 


I Name 
I Address 

By Catherine DeAngelis, M.D., R.N., M.P.H., F.A.A.P. 
The common goal of all textbooks is to impart know- 
ledge in a particular field. The purpose of this book is to 
fulfill that function in a special way. It is written to 
impart to members of the pediatric primary health care 
team specific, pertinent knowledge that has been care- 
fully selectf'd from the broad field of pediatrics. 
Certain areas, such as clinical nutrition, growth and 


For nurses in neurological and neurosurgical acute-care 
settings, medical-surgical and pediatric wards, and reha- 
bilitation units. A useful text for nursing education and 
clinical practice, it addresses the complexities of neuro- 
logical nursing that require nurses to know the precipi- 
tating factors, symptoms that often do not reflect 
etiology, and the required nursing care that often is the 
same for patients with different conditions. Contents: 


By Patricia McCall Comoss, R.N., CCRN.; et. al. 
One of the most exciting features of the rehabilitative 
approach to the patient with symptomatic coronary 
disease has been its progressive incorporation into the 
mainstream of traditional medical care. 

Nursing roles within the health care team may vary con- 
siderably, depending on the size of the patient popula- 
tion served, the scope and mode of organization of 
rehabilitation services, the extent of participation of the 
other health care disciplines in the rehabilitation team, 
the community medical practice customs, and so on. 
Lippincc. tto 334 Pages. Illustrated. 1979. $20.25. 

Little, Brown. 676 Pages. Illustrated. 
1979. Paper, $15.00. Cloth, $21.00. 

development problems, and health education, are presen- 
ted in depth. Whenever possible, physiologic processes, 
behavior problems, and diseases are explained from the 
developmental standpoint. The reference lists at the end 
of each chapter, however, contain many key articles to 
which the reader can refer for in-depth discussions. 
2nd Edition. 

By Susan Fickertt Wilson, M.N. 
Neuroanatomy and Physiology; Assessment of the 
Neurological Patient; Care of the Patient with Increased 
Intracranial Pressure; Care of the Unconscious Patient; 
Care of the Patient with Seizures; Care of the Patient 
with Aphasia; Principles of Neurodiagnosis; Injury to 
the Central Nervous System; Disruption of Circulation in 
the Brain; Infections of the Central Nervous System. 
Springer. 272 Pages. Illustrated. 1979. $21.00. 

J. B. Lippincott Co. of Canada Ltd. 
75 Horner Ave., Toronto, Onto M8Z 4X7 

o Payment enclosed 
(post. & hand. pd) 

Please send me the following 'on app 'l:' 
o Concept Formalization in Nursing 
o Pediatric Primary Care (P) or (Cl) 
U Neuro-nursing 
o Cardiac Rehabilitation 

U Bill me 
(plus postage and 

Provo _ Postal Code 

Prices subject to change without notice. 



Canadian nurses to write this." Laura Legge, RN, Q.c. made explicit in anyone of 
reminded intravenous nurses several conceptual models for 
CGFNS exams to work in U.S. at the recentC.I.N.A. nursing. 
conference that although they The development of 
may not be doing bedside Standards for Nursing 
The U.S. Immigration and Consideration will be nursing, they are very Practice represents a 
Naturalization Service has given to exempting foreign important and may be the only beginning phase in an attempt 
announced that, contrary to nurse graduates, including registered nurses that the to answer the question: "Does 
earlier statements, Canadian those from Canada, who have patient sees. She emphasized nursing make a difference?" 
nurses will not be exempted already passed the state' that patients do matter as she The Task Group believes that 
from the screening licensing examination commented on the increased standards must bë tested and 
examinations all foreign (SBTPE) in one of the states incidence oflegal suits validated in practice settings 
nurses wishing to work in the of the U.S., from having to involving hospitals, doctors to assure their usefulness. 
U.S. must write. take the CGFNS exam. and nurses. Meetings will be held 
The examinations, which The nextCGFNS The fourth annual monthly from January through 
are necessary in order to examination will be given convention of the Canadian April 1980; the final report is 
obtain an occupational April 2, 1980 in 28 cities Intravenous Nurses expected to be completed for 
preference visa{H-I), are outside the U.S. Exam sites in Association in Toronto last presentation to CNA's Board 
given by the Commission on Canada will include Montreal, November brought more than of Directors in June. 
Graduates of Foreign Nursing Toronto and Vancouver. 160 nurses together from 
Schools (CGFNS), Examination applications and across the country, including We invite and welcome your 
established under the Guidebooks for Applicants the Northwest Territories. comments, questions, 
sponsorship of the American are available from CGFNS, With the objectives of suggestions or criticisms. 
Nurses Association and the 3624 Market Street, facilitating idea exchange, Write: Pat Wallace, Project 
National League for Nursing. Philadelphia, PA. 19104. and upgrading knowledge and Director, The Canadian 
The April, 1980 exam will be from U.S. embassies and making available information Nurses Association, 50 The 
the fourth such screening national nurses' associations on much ofthe new Driveway, Ottawa, Ontario. 
offered by CGFNS. in foreign countries. Filing technology of IV therapy, the K2P 1E2. 
The day-longCGFNS deadline for the April exam conference presented a group 
exam tests the foreign nurses was January 15, 1980. The of highly qualified speakers Health happenings 
in nursing proficiency and nextCFGNS exam will be and a varied selection of On January 17th the first of a 
English comprehension. Both held October 1st, 1980; filing exhibits. . series of programs devoted to 
sections of the test are in deadline for this exam is July "demystifying health care" 
English. The nursing portion 14. Standards group for the Canadian consumer 
covers the same five subjects On the same day the Apnl was aired. Plans now call for 
included in U.S. state exam is given outside the "CNA is taking an innovative the series, The Medicine 
licensing exams, namely, U.S., it will be given in Los and leadership role in the Show, to consist of at least ten 
medical, obstetric, pediatric, Angeles, Houston, Chicago, development of a definition half-hour programs to be 
psychiatric and surgical Miami and New York for and standards of nursing shown weekly, dealing 
nursing. The CGFNS exam is foreign nurses who have not practice," says Pat Wallace, magazine-style with a. wide 
not a substitute for the state yet passed state licensing project director. Speaking on variety of topics related to 
board licensing exam. After examinations in this country. behalf of the group of seven medicine and health care in 
passing theCGFNS test, Testing in the U.S. is an (see The Canadian Nurse, Canada. 
applicants are required to take accommodation for foreign October 1979), WaIlace Of special interest to 
and pass the state licensing nurse graduates who are reported to CNA directors last nurses will be the program 
exam in the U.S. applying to the U.S. Fall that the committee has filmed in Winnipeg in which 
According to Virginia Immigration and adopted the principle that a the host, author and 
Jarratt, RN, PhO, president of Naturalization Service for an conceptual model for nursing broadcaster Ken Lefolii, 
the CGFNS board of trustees, extension or a change in visa should be used to guide interviews a group of nurses 
by detennining nurses' ability status. The exams in the U.S. practice regardless of the and asks for their frank 
to pass a state licensing exam wiIl eliminate the need for setting in which that practice opinion about the 
before they come to the U.S., these nurses. from Canada occurs. It wants this principle effecti veness of systems of 
theCGFNS exam helps and other countries, to return built into the definition and health care delivery in 
foreign nurses who are not to their homes to take the standards. Canada. Also planned is a 
fuIly prepared for professional CGFNSexam. The Task Group has program which deals with the 
practice in this country to based its decision on a belief image of the nurse as 
avoid the disappointment, IV nurses exchange that the emphasis in nursing presented in contemporary 
relocation costs and possible has shifted from a popular literature, including 
exploitation foreign nurses information, ideas predominantly dependent role Harlequin romances. 
have experienced in the past. toward a more independent The Medicine Show is 
"TheCGFNS screening "Relationships are very role, one that requires scheduled to be seen on major 
procedure also helps assure important: nurses must take clarification in order to CBC stations Thursday 
the American public of the time to speak to their specify nursing's unique evenings at 9:30, but local TV 
minimum safe health care," patients...many nurses and contribution to societal health listings should be checked for 
Dr. Jarratt said. doctors seem to be forgetting needs. This uniqueness is time and availabi ity. '" 

The )
o' ANew 
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The traditional method of mixing potassium chloride 
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A new solution is our Pre-Mixed K CI which permits 
the delivery of desired amounts of K CI to patients. 
K CI is the single most common drug additive used in 
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were required to add KCI to solutions manually which 
can be extremely time consuming. New Pre-Mixed K CI in 
the proven Viaflex
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Pre-mixed K CI solutions greatly reduce the potential for 
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Today's diabetics have a healthier out- 
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quality care 
for the cancer patient 
A complex relationship exists between the skilled and 
knowledgeable nurse and the well-informed patient 
receiving chemotherapy. Here's how a holistic approach 
can enhance your treatment plan and encourage 
patient compliance. 

Diana Law 

From diagnosis to death, cancer patients 
face one crisis after another in life: the 
initial diagnosis of a life-threatening 
illness. the discomfort of treatment, the 
unknown of a treatment regimen and 
possible recurrence of the disease 
followed by more treatment. Patient 
responses to any form of medical 
treatment are always both physiological 
and psychological: in cancer patients the 
latter effect is aggravated severely by the 
gravity of their disease and the 
continually investigative nature of their 
therapy. Disturbances in interpersonal 
relationships result along with 
physiological changes and psychosocial 
"equally as stressful as a confrontation 
with mortality are the other threats that 
cancer holds. Feelings of worthlessness 
due to the patient's feelings of 
un productivity while ill. dependency, 
altered body image, role dysfunction, 
fears of alienation. social isolation and of 
stigmatization and anxiety over the 
physical symptoms such as pain, all may 
plague the patient concurrently. "1 
The nurse who is equipped with 
knowledge and skill can offer support to 
the patient on chemotherapy through a 
holistic approach to patient care. But, to 
accomplish this, you must look at and 
care for the patient as a whole person: 
his care cannot be 'atomized' into 
different parts. 
Remember, chemotherapy does 
work: to the patient receiving the drugs 
they offer hope, and what you know 
about cancer and chemotherapy can be a 
determining factor in how the patient and 
his family adjust to the fearful 
circumstances of his illness and 
treatment regime. 

re more sophisticated in 
their awareness of medicine these days, 
and our patients now come to us fairly 
well-informed, and with questions that 
demand intelligent answers. The nurse 
who stays current with her skills and 
knowledge has a better understanding of 
the whole treatment process and this in 
turn gives her a degree of confidence and 
control which she can communicate to 
her patients. 

Chemotherapy - how it works 
Cancer has been defined as uncontrolled 
proliferative cell growth which is harmful 
to normal physiological function. For 
example. in acute lymphocytic leukemia 
there is rapid proliferation of the 
lymphocyte stem cell line with a 
resultant rise in the number of circulating 
lymphocytes and decreased cell quality. 
Normal growth of other stem cell lines is 
greatly affected. 
The basics of the cell cycle may be 
reviewed by means of a simple diagram 
(See Figure one). 
GO - in this stage the cell is at rest until 
some internal mechanism triggers the 
GI- RNA and protein synthesis begin 
S - in this phase DNA synthesis occurs. 
DNA is housed in the nucleus of the cell 
and contains all the genetic requirements 
for regulation of the vital cell processes 
such as growth, differentiation, 
specialization, etc. 

Tha r.I"I...tI_1"I 1.I..r.. 













. :






G2 -little is known about what goes on 
in this fairly quiet period except that 
some RNA synthesis occurs. 
M - mitosis occurs at this stage; the cell 
divides into two "daughter" cells 
containing all genetic information. Each 
cell will now mature and repeat the 
cycle, or go into the GO stage. 
A complete cycle is referred to as 
one generation time. 
Cancer is a disease of the ceIl and so 
the chemotherapeutic agents work in 
different ways on the life cycle ofthe 
cell. Some drugs are ceIl-cycle specific 
- that is, they interfere with cell activity 
at a specific phase - while others are 
not. The drugs may be grouped into four 
categories according to their mechanism 
of action. 
I) Antimetabo/ites These drugs are 
cell-cycle specific in that they interfere 
with metabolites essential for DNA 
synthesis. For example, methotrexate 
interferes with the enzyme dihydrofolate 
reductase, which is necessary for folic 
acid synthesis and subsequent synthesis 
of DNA. 
2) Antibiotics Non-cell-cycle specific, 
these drugs react by binding to DNA at 
any stage of the cycle añd interfere with 
the transcription ofRNA and protein 
synthesis. Example: AdriamycinJ!)_ 
3)A/ka/oids Cell-cycle specific drugs 
which interfere with the mitotic spindle 
in cell division. Example: vincristine. 
4) Hormones These drugs alter the 
cellular metabolism of the body by 
changing the hormonal milieu and 
making it unfavorable for tumor growth. 
Example: the use of estrogens in patients 
with cancer of the prostate gland. 

Each drug dose kiIls some but not all 
the neoplastic cell population; the effect 
is more noticeable when a high 
percentage of cells are actively and 
rapidly dividing within a malignancy. 
The bone marrow and lymphoid 
components are good examples of highly 
proliferative tissues that are sensitive to 
chemotherapeutic agents. Nerve tissue, 
on the other hand, has a low percentage 
of celIs dividing and is therefore less 
sensitive to these drugs. The goal of drug 
therapy is to destroy every abnormal 
cell, but the toxicity of the drug imposes 
limits on the dose that can be 
administered. Combinations of drugs are 
designed to maximize the therapeutic 
benefits of each drug in the combination, 
but to avoid overlapping toxicities: for 
example, vincristine causes little bone 
marrow depression as a side effect while 
Adriamycin causes significant bone 
marrow depression. 
Unfortunately antineoplastic agents 
also attack normal cells. They will do 
most damage to highly proliferative cells 
and consequently their toxic effects are 
felt most keenly on the G.I. mucosa, hair 
follicles, bone marrow and skin. 
To allow the normal tissues to repair 
themselves, drugs are given in cycles to 
provide drug free intervals. 

A posith'e attitude 
The patient receiving cancer 
chemotherapy does much better during 
treatment when he knows what to 
expect. Patients who are weIl-informed 
about their disease and its treatment, 
about the possible adverse effects and 
results, generaIly take appropriate action 



Cell life cycle 


20 F.bruary 1810 


The Cenadlan Nuree 

on their own at the first sign of 
complications. The nurse's knowledge of 
drug toxicity. psychological trauma and 
the nursing care of both can playa major 
role in aIlaying much of the fear and 
anxiety brought on by the unknown. 
Both the nurse and the patient and 
his family need to know what can be 
done to prevent complications of 
treatment both in hospital and at home, 
and how to treat the unavoidable side 
effects. Both need to know the difference 
between a tolerable side effect and an 
acute toxic reaction. 
A useful tool in patient teaching is 
the pamphlet or booklet used on a 
nursing unit which describes in clear 
language the basics of chemotherapy. 
Not meant to be a substitute for the 
nurse's presence in explanations, 
reading material can be an exceIlent 
facilitator to information assimilation if 
nurse and patient go over the material 
It is important however to consider 
not only the negative aspects of cancer 
chemotherapy, but to help your patient 
develop as positive an attitude toward 
his therapy as possible. You can ensure 
that both he and his family are aware of 
the potential benefits as well as the risks 
Chemotherapy requires a high degree of 
co-operation among all concerned, and 
patients and families should be partners 
with hospital staff in the care process. 
At the outset, assess the patient's 
attitude and general level ofanxiety. 
Listen to him, watch his body language 
and try to understand just how he 
perceives his disease and treatment plan. 
In this way you can gear your teaching 
plan to suit his individual level of 
tolerance and understanding, taking into 
consideration all the factors of culture, 
personality and psychosocial 
Knowledge of his disease and 
treatment gives the cancer patient some 
measure of control over a potentially 
uncontrollable situation. Through 
participation in his own treatment and 
good teaching, nurses can strive to 
increase the degree of patient 
compliance. This is possible only if, as 
mentioned earlier, both the patient and 
his family are fully cognizant of 
chemotherapy and its implications. 

Eighteen-year-old Alex, for 
example. who has a diagnosis of 
osteogenic sarcoma, returns to the 
hospital at regular intervals for his 
chemotherapy which involves high doses 
of methotrexate with citrovorum rescue. 
After each session of chemotherapy, 
Alex is discharged providing that his 
laboratory results are within normal 
limits. to complete his treatment cycle at 
home. This includes taking the oral 
citrovorum rescue drug on time every 
day. keeping himself adequately 
hydrated according to the protocol and 
testing urine pH. The latter is a good 
example of Alex's self-care: ifhis urine 
pH falls below 7, he takes an appropriate 
dose of soda bicarbonate to alkalinize his 
All patients benefit from a card or 
handout given at the time of discharge 
that outlines their responsibilities at 
home. Patient compliance is very 
important in chemotherapy, and 
successful treatment requires that all 
involved be well-educated. informed and 
responsible about the home phase of the 
treatment cycle. 

Toxicity: how it affects the nurse and the 
Here is a short review of the most 
common side effects of chemotherapy, 
along with the nursing actions that can be 
taken while the patient is in hospital and 
simple remedies the patient himself can 
use at home. 

. Leu!..openia 
Leukopenia results from suppression of 
bone marrow function and is one of the 
most serious toxic effect
 of cancer 
chemotherapy. The white cell count is 
lowered. particularly the neutrophils that 
combat bacterial infection: thus 
susceptibility is increased and the patient 
may be infected by hi" own nonnal body 
Nursing actions include inspection 
of all body orifices for early signs of 
infection. and instruction to the patient 
on how to keep himself clean and avoid 
problems. Rectal abscesses and fistulas 
are common in leukopenic patients 
whose nutritional status is compromised. 
Temperature and the white cell count 
should be monitored closely; if the WBC 
falls below 1000/cu mm the patient may 
be put on reverse isolation. 

Reverse isolation, obviously, is the 
reverse of usual hospital isolation - the 
goal is to protect the patient from outside 
infection sources. He may be put into a 
private room, and all persons entering 
the room will have to wear masks; gowns 
may be worn when direct contact is 
made and strict handwashing technique 
Another area of concern with the 
leukopenic patient is the preparation of 
venipuncture sites; betadine solution 
followed by alcohol is used prior to 
puncture. The needle is secured in place 
with tape, but tape is not placed over the 
needle site itself; a sterile 2x2" gauze 
dressing with betadine ointment may be 
used and changed daily. The IV site 
should be changed every 48 hours if this 
is possible. to avoid infectiono Any 
dennal abrasions sustained by the 
patient may be treated a
venipuncture 0 
Not to be forgotten are the 
psychological repercussions ofreverse 
isolation; the patient will need more 
support than ever to combat fear and 
loneliness and the anxieties that come 
from social isolation and increased 
dependence 0 





ie Folic Acid 

The Canadian Nur.. 

The patient himself can do a number 
of things to ameliorate leukopenia: he 
can keep hImself clean and report any 
pain or discomfort such as on voiding 
etc. While in reverse isolation, he Can 
use saline and hydrogen peroxide 
mouthwashes every three hours. These 
take the place of using a toothbrush 
which injures sensitive gum tissue. 
Mycostatin mouthwashes may be 
prescribed to prevent candidas infection. 

. Thrombocytopenia 
This is also an effect of bone marrow 
depression, the principal sign of which is 
bleeding. In some patients. bleeding may 
occur at platelet counts of 50,OOO/cu mm 
(normal range is 140,000 to 400,OOO/cu 
mm) while not in others until counts are 
below 20,000. 
Nursing actions include watching 
for obvious signs of bleeding, as well as 
observing for joint pain, pelechiae, 
hematuria and headaches which may 
herald a bleed into the brain. Patients' 
rooms should be uncluttered to prevent 
accidental falls or bruises and 1M 
injections and ASA should not be 




Cell Division 

Februery 1910 21 

The patient himself can watch for 
and report any signs of bleeding such as 
nosebleeds or bruising. He can take care 
in his activities to avoid cuts or any kind 
of trauma; in addition he should know 
not to use a toothbrush to prevent gum 
bleeding, and not to use alcohol or ASA 
unless his doctor approves. 
Thrombocytopenia can sometimes 
be temporarily improved with platelet 
transfusions. but often after a number of 
these transfusions patients develop 
antibodies and need to be premedicated 
with a drug such as Benadryl
 prior to 
further transfusion. 

This side effect of chemotherapy is yet 
another result of bone marrow 
depression evidenced by decreased red 
blood cell count and anemia. 
Nursing actions include planning 
patient care to allow for frequent rest 
periods, and provision of adequate 
nutrition, especially foods high in iron. 
The nurse should watch for signs of 
anginal pain on exertion in patients who 
are otherwise already compromised- 
those who are elderly or who hiwe 
The patient himself should know not 
to tire himself and when at home to plan 
frequent rest periods; he can watch his 
diet as well and use liquid protein 
supplements if necessary. 

. Anorexia, nausea and \'omitinR 
These side effects, alone or all together, 
are common to almost all the 
chemotherapeutic agents, but they can 
be alleviated with relative ease in 
intelligent management. 
It is useful for the nurse to assist the 
patient to develop an eating pattern so 
that at certain times following 
chemotherapy and/or antiemetic 
medication, he will feel able to eat. Other 
apparently minor but helpful nursing 
actions include making the patient as 
comfortable as possible at mealtimes. 
presenting attractive meals - food 
cooked at home is excellent if not 
contraindicated - and the provision of 
liquid protein supplements in the form of 
eggnogs or Sustacalí' when solid food 
cannot be taken. Mouth care before and 
after meals helps too to overcome the 
'bad taste' that may adversely affect 
The patient himself can report to the 
nurse any nausea or vomiting he 
experiences so that he may be given 
antiemetics before meals, and he can 
encourage his family to bring food from 
home ifthis is allowed. 

22 FebrU8ry1980 

. Diarrhea 
Patients receiving antibiotics and 
antimetabolite chemotherapy drugs are 
commonly afflicted with this side effect. 
Nursing actions are aimed at 
treating the symptoms which can be 
accomplished by providing the patient 
with a low roughage diet high in foods 
that tend to constipate, such as cheese 
and boiled milk. Fluid loss must be 
replaced and good skin care is imperative 
if diarrhea is severe, antidiarrheals such 
as Lomotil@ may be necessary. 
The patient should be asked to 
report the incidence of diarrhea as soon 
as it starts to his nurse or doctor. and he 
can watch his diet and fluid intake. 

. Stomatitis 
Inflammation of the mucous membranes 
of the mouth often appears as a sign of 
toxicity from the antimetabolite and 
antibiotic drugs. Painful mouth ulcers 
make eating difficult and may progress to 
severe infections. 
Good oral hygiene is an important 
nursing action using frequent 
mouthwashes of I: I saline hydrogen 
peroxide solution; these will improve 
taste and reduce bacteria. A topical 
anesthetic such as viscous Xylocaine 1Þ 
may be helpful before meals in severe 
cases, and antacids may be helpful when 
esophagitis is also present: bland foods 
of medium temperature and high protein 
fluids should be provided. 
Reporting the appearance of mouth 
sores or pain is the patient's 
responsibility and he can initiate the 
mouthwashes mentioned above 0 

. Alopecia 
Hair loss can be devastating to the 
patient's self-image, especially when it 
occurs s uddenl y 0 Hair follicles 
proliferate cells rapidly and are 
consequently damaged as much as 
malignant cells in chemotherapy. 
The nurse can assure the patient that 
the condition is reversible and that once 
chemotherapy is stopped hair growth 
will resume in four to six weeks. Recent 
research has shown that the application 
of a tourniquet around the head or an ice 
bag to the scalp while chemotherapy is 
being given actually reduces hair [oss: 
the blood flow to the scalp is restricted 
and so the chemotherapeutic agent does 
not reach the hair follicles in the same 
concentration. Of obvious benefit too are 

The Canedl.n Nur.. 

The patient, once informed by 
nursing and medical staff that alopecia 
may occur. can prepare his family and 
friends for the change in his appearance. 

These are only the most common of 
the side effects of chemotherapeutic 
agents; several others ex ist - effects on 
the reproductive system for instance- 
and nurses should be aware both of the 
actual effects and of how to help the 
patient alleviate them. 

Creative caring 
The patient with cancer who is 
undergoing chemotherapy is a 
tremendous challenge to a nurse; besides 
continuously updating her basic 
knowledge of drugs. their actions and 
interactions, she must draw on her 
personal talents and resources, plus 
those in the community around her, to 
foster a positive and hopeful attitude in 
her patient. How both nurse and patient 
perceive and accept the disease of cancer 
and its treatment have a profound effect 
on the success of chemotherapy. 

1 Welch, Deborah. Assessing 
psychosocial needs involved in cancer 
patient care during treatment. 
Oncol.Nurs.Forum 6:1:13.Jan. 1979. 

1 Chemotherapy of cancer. Adria 
Laboratories, Sepo, Oct., Nov. 1976. 
2 Marino, E[izabeth. Cancer 
chemotherapy, by Elizabeth Marino and 
D.H. LeBlanc. Nursing'75 5:11:22-23, 
Nov. 1975. 
3 Peterson, Barbara H. Current 
practice in oncologic nursing, by 
Barbara H. Peterson and Carolyn J. 
Kelloggo Vol. I. St. Louis, Mosby, 1976. 
4 Welch, Deborah. Assessing 
psychosocial needs involved in cancer 
patient care during treatment. 
Oncol.Nurs.Forum 6:1:12-18,Jan. 1979. 

Diana C. Law,RN, BScN. is a Rraduate 
of the Toronto General Hospital School 
of Nursing and has completed a 
post-graduate course in psychiatric 
nursing as well as her baccalaureate 
degree which she obtained from the 
Uni\'ersity of Alberta 0 She is presentlv 
workinR as the medical nursinR 
co-ordinator at the Foothills Hospital in 
Calgary where, she writes, "we are 
de\'elopinR stafr and patient teaching 
programs related to oncoloRY." 

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. -- 

Taking the bite out of Winter 

The C.nadlan Nur.. 

Februery 1910 23 

treat t 
r an acute 
noxic Incident 

Stephanie and her six-year-old playmate, Marc, were fascinated by the 
spring thaw. Playing on the brink of the river, pokin
 with sticks at pieces of 
floating ice and throwing rocks into the murky water, they were feeling the 
freedom of spring. Suddenly, Stephanie lost her footing and fell into the icy 
water. Marc, terrified by her screams, ran for help. Ten minutes later, 
Stephanie was pulled from the water, not breathing and without a pulse. 
Cardiopulmonary resuscitation was initiated by a rescuing policeman while 
bystanders waited for an ambulance. What followed for Stephanie's parents 
and the medical staff that cared for her were ten days of anxious waiting - 
ten days of not knowing what the results of their treatment and the eventual 
outcome would be. 

I 'J ,11 

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74 F"tw"lIrv 1QM 

Th. r...,........, "lire. 


Controlled hypothermia 
The treatment of choice for a victim of 
accidental hypothermia and acute anoxic 
episode is controlled hypothermia and 
barbiturate induced coma until cerebral 
edema is resolved. 
Controlled hypothermia, the 
external regulation of body temperature 
10 below 33.3 0 c. is used in medicine for 
several purposes: 
. to lower excessively high fevers of 
febrile disease entities, including drug 
and anesthetic reactions, such as 
malignant hyperthermia 
. to reduce oxygen con
umption and 
control bleeding intraoperatively, such 
as in cardiac surgery 
. to reduce cerebral edema secondary 
to metabolic or mechanical injuries of the 
Use of hypothermia results in a 
reduction of basal metabolism, 
decreased respiratory rate, pulse, blood 
pressure. hormonal response and cellular 
oxygen requirements. As hypothermia 
tends to reduce cerebral blood flow, the 
fluid shift from intravascular to 
intracellular areas is decreased and the 
nervous tissue need for oxygen is 
reduced. For these reasons, controlled 
hypothermia is frequently used in 
conjunction With other supportive 
measures in the care of patients with 
cerebral edema second dry to brain 

Barbiturate induced coma 
Continuous coma produced purposefully 
by hourly infusion
usually thiopental sodium (Pentothal@ 
Sodium). pentobarbital sodium or 
phenobarbital (dosage of 1-5 mg/kg/hr) 
has been ..hown to reduce intracranial 
pressure (ICP) in palients having 
increased ICP due to cerebral edemao' 
Although the exact mechanism that 
reduces the intracranial pressure is not 
well understood. a reduction of cellular 
cerebral metabolism and cerebral blood 
flow have been identified as important 
aspects of the process. 
Barbiturate induced coma renders 
the patienl without cerebral function (no 
reflexes or spontaneous movement) and 
can produce a temporary flat (isoelectric) 
electroencephalogram (EEG) and fixed, 
dilated pupils. This treatment is used in 
conjunction with intracranial pressure 
monitoring. mechanical ventilation. 
anticerehral edema medication and 
frequently hypothermia until the critical 
period for cerebral edema has passed. At 
that time barbiturate., are discontinued 
and while the ICP is carefully monitored 
the patient is "allowed to wake up". 

.' æ 

. OIl 


:\Ionitoring intracranial pr
Intracranial pressure is the cumulative 
force exerted within the skull by the 
brain. cerebral blood flow and 
cerebrospinal fluid (CSF). This pressure 
is readily affected by any change in 
volume of any of these three elements. as 
the fixed and rigid nature of the cranium 
does not allow compensation for 
variations. Any increase in these 
volumes results in an increase in ICP. 
commonly seen wilh space occupying 
lesions. intracranial hemorrhage. build 
up ofCSF secondary to a blockage of the 
skull drainage system and cerebral 
Cerebral edema is the pathologic 
shift of water and sodium from 
surrounding blood vessels into brain 
cells in response to brain injury either 
mechanical (closed head injury) or 
metabolic (acute anoxic incident). The 
edema fluid is rich in proteins which 
have leaked through the capillaries into 
the cells and thereby cause an osmotic 
pull of more fluid into the inlracellular 
and interstitial fluid spaces. 
With increased ICP. cerebral 
function is threatened. If the ICP is not 
adequately controlled, severe brain 
damage can result. Wilh new monitoring 
devices that place a small probe in Ihe 
CSF surrounding the brain. ICP can be 
measured directly. The indirect signs of 
ICP -level of consciou
ness. size and 
reaction of pupils to light. vital signs and 
motor respon.,e - are essential in 
evaluating neurologic status but are not 
usually evident until some pathologic 
change has occurred to the brain. ICP 
monitoring is a useful adjunct in the care 
of patients with head trauma. pre and 
post operative craniolomies. intracranial 
hemorrhage and di...ease processes 
characterized by cerebral edema. 
:\Ieasured in the same scale as 
arterial blood pressure to allow for 
comparisons. normallCP ranges from 
4-15 mm/Hg2. Elevations of ICP can be 
treated with medications such as 
\Iannitol and Dexamethasone: with 
barbiturate induced coma. hypothermia. 
hyperventilation and in some cases 
neurosurgery (skull decompression and 
CSF drainage). 

Stephanie's stor) 
Stephanie. aged five and one-half years, 
was brought to the Emergency Room of 
a nearby general hospital by ambulance 
after submersion in a very cold 
freshwater river for ten minutes \Iouth 
to mouth resuscitation and cardiac 
massage were started at the scene and 
continued until the child was intubated 
and ventilated in the E.R. and heart 
function had returned to sinus 
bradycardia with a rate of 46 per minule 

On arrival at the E.R.. Stephanie 
was described as being apneic and 
asystolic. with pupils fixed and dilated. 
Rectal temperature on admission was 
26 0 C. Following initial resuscitation and 
stabilization. large loading doses of 
intravenous Pentothal" Sodium were 
given and a paracentesis involving 
instillation of warmed saline into her 
abdomen was performed in an attempt 10 
raise her body temperature above the 
critical level of 30 o C. Below this 
temperature, cardiac arrhythmias and 
ventricular fibrillation which are difficult 
to reverse are common. 
At the local children's hospital. to 
which she was transferred, Stephanie 
was taken immediately to the ICU and 
placed on a hypo/hyperthermia blanket 
and under an overbed healer as the 
attempt continued to raise her core 
temperature to 30 o C. She was ventilated 
with 100 per cent oxygen initially and 
PEEP IPo...itive End Expiratory 
Pressure) was used to reduce pulmonary 
edema. PEEP mainlains inflation of all 
areas and segments of the lungs. By 
maintaining positive pressure in the 
alveoli on expiration. the normal 
transudation of fluid across Ihe alveolar 
capillary membrane is relarded. 
Stephanie was attached to cardiac 
and respiratory monitors. vital and 
neurological signs were ""atched closely 
and a foley catheter and naso-gastric 
tube were inserted. On admi...sion. 
fulminant pulmonary edema was treated 
""ith stat doses of intravenous 
furosemide (Lasix H). She was then taken 
to the neurosurgical operating room 
where an intracranial pressure probe was 
inserted. As the probe was covered with 
an occlusive dressing. the only nursing 
care of this closed system involved 
accurate readings and awarene", of 
implications of changes. 
Stephanie's care. da}'-to-day 
condition. her ongoing medications and 
treatments during her stay in ICU are all 
illustrated on the accompanying chart. 
The barbiturate induced coma which 
had been initiated at Ihe general hospital 
E.R. was maintained with hourly 
injections of Pentothal" 150 mgm 
intravenously which were reduced to 40 
mgm/hr. Decadron . a long-acting 
synthetic adrenoconicoid. was 
administered routinely as its intense 
anti-inflammatory activity is e"pecially 
effective in reducing cerebral edema. 
Ampicillin therapy was also begun at this 
Controlled hypothermia ""dS 
initiated once Stephanie's temperature 
had been raised to 32 0 C and until day 
four her temperature was regulated 
between 30 and 32 0 C 

The Cenadlan Nur.. 

With the use of hypothermia and 
barbiturate induced coma, Stephanie's 
blood pressure was very low and 
unstable. To determine that there were 
no other causes of her labile status. tests 
indicated on the chart were compleled 
regularly with a special focus on serum 
Pentothal" levels. Any measurement 
outside of the desired 2.5-5 mgm per cent 
range resulted in adjustment ofthe 
hourly infusion dosage. By day three, the 
unstable blood pressure recordings 
coupled with a low hematocrit resulted in 
the infusion of packed cells. Even though 
the cause of this persistent blood 
pressure problem was probably the 
treatment regime. Stephanie' s 
management could not be continued 
without further infusions of fresh frozen 
plasma and then albumin. 
On day four. a gradual and slo"" 
rewarming process was initiated. Over 
24 hours. Slephanie's temperalure was 
increased to the normal range. although 
she did require external regulation of 
body temperature until day six. As 
cerebral function returned. the brain 
could then regulate body temperature 
without external assislance. Concurrent 
with rewarming. the Penlothal" infusions 
were discontinued. Consequently. 
pupillary response to light returned full} 
within 24 hours. Note that with 
rewarming and the discontinuing of 
barbitumtes. the effects of hypothermia 
were reduced. that is. lhe apical pulse 
and blood pressure increa...ed and the 
intracranial pressure rose ...Iightly. The 
following day. day five. spontaneous 
respirations were noted and by day 
seven. Stephanie was opening her eyes 
to command. withdrawing limbs to 
painful stimulation and breathing at a 
rate of 30- 36 per minute. Complete 
recovery from lhe effech of the 
barbiturate induced coma and 
hypothermia was evident on day eight 
when Stephanie was extubated and she 
staned 10 speak. 
During thi.. period. Stephanie's 
general care involved all of the normal 
aspecls of nursing care of the 
unconscious. mechanically ventilated 
patieni. including eye. mouth and skin 
care. passive exercises. etc. Chest 
physiotherapy was initiated only on day 
four as active chest physio is sometimes 
contraindicated for the individual with an 
unstable ICP. At this time physio was 
given every two hours to minimize the 
severe problem of atelectasis that had 
developed despite the use of PEEP. 

Fabru.rv 1!MO 25 

AdmissÌCIn Day anti Day two Day thrle Day four 
Body oC Initially 26 0 Controlled Hypothermia 30.5 0 then warmed to 
tempereture warmed to 32 0 30--32 0 30--32 0 30.5-31 0 37 0 over 24 hours 
Vital signs 
Apex 48--70 68-----B0 6D----a0 52-64 56---90 After warming 
Blood pressure 5CJ-..1J0 6D----a0 6D----a0 7D----a0 60--90 After warming 
{Systolic) Respirations Mechanically ventilated Mechanically ventilated Mechanically ventilated Mechanically ventilated 
mechanically ventilated at 15/minute at 121minute at 121minute at 121minute 
at 21/minute 
Neurologic signs Fixed at 0700 hrs 
Pupils Fixed and dilated Reacting sluggishly 
Eye opening None at 1200 
Vemal response None Reacting moderately 
Motor response None at 2200 

ICP (mm Hgi 
Normal (5-15 mm Hg) 1-3 1--5 2--5 1-5 2-8 
Medications Pentothalq!) Pentothallll> Pentothal III> 
15Dmgm IVOIH reduæd to 40 mgm 01H discontinued 
Oecadronlll> Oecadronlll> at 0700 hrs 
6 mgm IV Q6H reduced to 3 mgm 08H 
1 Gm IV06H 
Oilantinq!) 30 mgm IV OSH 
475 mgm IV 06H 
Stat Medications Lasixq!) 20 mgm IV Oilantinlll> 100 mgm IV Lasixq!) 20 mgm IV 
Tests Arterial Blood Cases* Chest X-Rayo Cross and type 
CBC*. Platelets, EEG EEG EEG 
Bun*, Electrolytes* ECG ECG 
Calcium*. Creatine Serum Pentothal Levels Trachea I Aspirate Serum Pentothal Leve Is 
Serum and Unne* (desired levels forC&S 
Osmolarity 25-5 mgm%) 
Notes *Oone dailv and more oOone daily for Packed cell infusion Fresh frozen plasma 
frequently during days 1-8 of 200 cc infusion of 150 cc 
days 1--5 as needed Phys iotherapy (chest) 

Stephanie's labile blood pres
precluded prolonged turning and change 
of position, so fastidious skin care every 
two hours was necessary to protect her 
from problems arising from pressure or 
cold to her poorly nourished skin. 

A happy ending 
The demands of the technical 
management of a case such as 
Stephanie's are outweighed only by the 
psycho-emotional demands. For seven 
days Stephanie's prognosis was very 
guarded, no one could predict whether or 
not she would be extremely brain 



damaged as a result of her severe anoxic 
dccident. Both medical and nursing staff 
were working in an apparent void: 
feedback to their treatment course was 
non-existent. Of course, this was mml 
difficult for Stephanie's parents. They 
could never be given much reassurance: 
all we could say was that her condition 
was unchanged and would remain that 
way until the treatment was over. Even 
by day 10. after active treatment had 
been discontinued and Stephanie was 
reacting fairly normally. the possibility 
of residual brain damage was not 
completely ruled out. 

Th. r-Qr>o "'Co .... '''C'. 

Now, a year later, Stephanie is at 
home. a full-time grade one student, with 
no apparent disabilities. Her EEG. 
respiratory function and cardiac status 
are all normal. Her only regular 
follow-up is with a local psychiatric 
clinic which is looking at some minor 
problems with "acting out". It would 
seem that the root of her problem is more 
likely to be a reaction to her instant 
"stardom" in the community than an 
organic manifestation. 'iii 

Day fiva Day lix Day leven Day eight Dey nine Dey ten 
36_5--37" Maintained 
36 5--37 0 36.5--37.3 0 hypothermia blanket 36.5--375 0 37 0 10ral) 367-37 0 
S6--1OO S0--1OO 86---100 70--100 
S0-90 86-100 00--100 90--100 
Mechanically ventilated Spontaneous respiration 36--Spontaneous 24--34 
at 13/minute with ventilator at a respirations with Not ventilated 
spontaneous resp. noted rate of 2O/minute mechanical ventilation 
Equal and reacting 
briskly to light 
Attempting To command To command Playing and reading 
Crying Mouthing words Talking "Want to go home" 
Spontaneous rrovement Withdrawal to Hand grips strong Alert and oriented 
gag and cough reflex pain toe pushes strong 10 person 
present and place 
3-10 0-10 5--13 2-11 ICP Probe Removed 

to 2 mgm IV QSH 

to 1 mgm IV 

asix(! 20 mgm IV 


Tracheal aspirate 
for C and S 

erum Pentothal levels 

Ibumin infusion 


Transferred to 

Nasogastric tube 
atheter removed 
Physio decreased to Q4H 
Up out of bed 

Hypothermia blanket 
turned off 

I Marshall, LF. Pentobarbital 
therapy for intracranial hypertension in 
metabolic coma, by LF. Marshall et al. 
Crit.CareMed. 6:1:1-5.Jan./Feb. 1978. 
2 Johnson. M. The subarachnoid 
screw. by M. Johnson andJ. Quinn. 
AmerJNurs. 77:3:448-450. Mar. 1977. 

I Beaumont. Estelle. 
H ypo/hyperthermia equipment.Nursing 
'744:4:34-41. Apr. 1974. 
2 *Conn,A.W.''Theroleof 
hypothermia in near-drowning." 
Toronto. Hospital for Sick Children, 

*Unable to verify in CNA Library 

Margot (Brown) ThomH
, a Rraduate of the 
Faculty ojNursin
. Vni
ity (
T omnto, 
IWIS part of the team who caredfiJr Stephanie 
(the pseudonym chosenIor the little Rirl in 
her article). Mar/?ot has worked in the 


n Nurse 

Sur/?icallntellSh'eCare Vnit of the Montreal 
General Hospital and is presently on .
tafJ in 
the I ntellSh'e Care V nit of the Children's 
pital of Eastern Ontario. 
Stephanie's sel l en-vear-old companion 
who went for help has since receh'ed a $/00 
award presented annually to a person who 
has made a 
pecial contrihution to the 
cOl1vnunity and the puliceman who dove into 
the frif?id waters and resCiled Stephanie will 
receh'e the Ontario Mechllfor Police 
Brewery. hisfÓurth hrm'ery awardfiJr thi
incident. He was quoted hy a 10m I 
newspaper as saying "My hig
was sa
'inR her life." 

__f.!!.1!r,!!!!.1911O 27 

Accidental Hypothermia: 

Donna Rae 

mer ency 

The correlation between a society, its physicaJ environment and the type of 
high risk activities its members engage in often affects the type of emergency 
treatments that must be perfected. In Canada, as our society becomes 
increasingly fitness oriented, outdoor activities in the most inclement 
conditions frequently result in accidental hypothermia. 

As an acute life-threatening emergency, 
accidental hypothennia requires 
immediate and active therapy. Although 
the ethical nature of inducing 
hypothermia for experimental reasons 
has restricted the amount of and quality 
ofresearch that has been documented, 
the statistics that are available along with 
the relevant case histories, have helped 
to identify reasonable approaches to 
emergency treatment. 
Accidental hypothennia occurs 
when the body's core temperature falls 
to less than 35 0 C (95 0 F) as a result of 
exposure to cold. Immersion in water or 
prolonged exposure to cold weather may 
result in this hypothennic state. Infants 
with poor thennoregulatory mechanisms 
and elderly people whose lower basal 
metabolic rates are coupled with 
debilitating disorders are particularly 

Bodily response to cold involves several 
. Heat C onsen'ation: Reflex 
responses which are activated by cold 
are controlled by the posterior 
hypothalamus and either increase heat 
production or decrease heat loss. 
Shivering, hunger, increased voluntary 
activity and increased secretion of 
norepinephrine and epinephrine are all 
mechanisms which increase heat 
production; while cutaneous 
vasoconstriction, curling up and 
honipulation (goose flesh) decrease heat 
Shivering, an involuntary response 
to cold and fear, is mediated by the 
shivering center in the posterior 
hypothalamus. As skeletal muscle tone 
increases throughout the body, the 
individual begins to tremble when a high 
level of muscle tension is reached. These 

U '\ 

tremors may vary from slight quivering 
to violent contractions which result in an 
increase in muscle cell metabolism and a 
consequent elevation of heat production 
The catecholamine hormones, 
norepinephrine and epinephrine, 
released primarily from the adrenal 
medulla as a response to any stressor 
including cold, increase the force and 
rate of contraction of the heart. 
Norepinephrine produces 
vasoconstriction in peripheral vessels 
while epinephrine released into the 
circulation increases the rate of cellular 
metabolism. As basal metabolism 
increases with decreased temperature, 







;.. .i;:, 


T..... l"".....-' .......

the need for oxygen consumption 
increases and the cardinal sign of 
increased respiratory rate becomes 
Honipulation, goose flesh, raises 
the hairs on the skin thereby providing 
pockets.ofinsulation. This is an effective 
means of conserving heat in lower 
animals who have an abundance of hair, 
however, the effectiveness of this 
response in man would seem to be of 
little consequenceo 
Despite compensatory mechanisms 
prolonged exposure to cold results in 
heat loss, lowered core temperature, 
declining metabolic rate, reduced 
shi vering and muscle rigidity. 
· Circularory SysTem: Initially with 
the response of increased metabolic rate 
and sympathetic activity, an increase in 


.-' \", 
, i 




,: .\ 











respiratory minute volume. heart rate 
and cardiac output is evident. Continued 
exposure to cold, however, results in 
depression of the medullary respiratory 
center, cardiac pacemaker acti vity and 
conduction, causing decreased 
respiratory rate, heart rate and cardiac 
output which may lead to hypotension. 
When core body temperature falls belo\\ 
32"C. the ensuing myocardial irritability 
may induce arrhythmias or heart block. 
In fact, "Once cardiac temperature falls 
to about 31"C, the cardiac output 
decljnes. At about 25"C, it often becomes 
insufficient to meet even the reduced 
requirements ofthe body tissues for 
oxygen and with further cooling the heart 
may stop completely. ,., 
Hypothermic victims are at high risk 
to develop ventricular fibrillation and 
cardiac dysrhythmias due to a decrease 
in oxygen supply to the cardiac muscles. 
As the body temperature drops, it 
becomes more difficult for oxygen to be 
released from hemoglobin resulting in a 
reduction in oxygen available for cell 
use.tThe consequent irritability of the 
heart places the patient at risk to cardiac 
. Nen'ous System: Below 32 0 C a 
progressi ve depression of the central 
nervous system including altered mental 
state, depressed reflexes and advancing 
coma may be noted as hypothermia is 
. Renal Responses: As hypothermia 
develops. renal arterioles constrict and 
cardiac output decreases causing a 
decline in renal blood flow, glomerular 
fit tration rate 
nd finall y , 01 iguria. As 
renal tubular function is depressed, the 
transport mechanisms are impaired 
resulting in deviant regulation of volume 
and concentration of fluids, acids, bases 
and waste products such as creatine, 
creatinine and uric acid. 
. Acidosis: Carbon dioxide, not 
effectively exhaled as a result of 
decreased respiratory minute volume 
and tissue hypoxia, which predisposes 
anaerobic metabolism, result in acidosis, 
both respiratory and metabolic. 

Assessment and treatment 
In an emergency situation such as this. 
assessment and treatment must be 
established according to priorities. 
I) Airway: Utilizing the A(airway), 
B(breathing), C(circulation) guidelines 
for determining priorities, a patent 
airway and respiratory adequacy must be 
assessed and treated first. Movement of 
air may be evaluated by observing the 
patient for respiratory effort and 
movement of chest or upper abdomen. 

When dubious air exchange is assessed, 
treat the patient by tilting the head back 
as far as possible by placing one hand 
under the neck while placing the other 
hand on the foreheado Forward 
displacement of the lower jaw in addition 
to head tilt may be required to extend the 
neck and lift the tongue away from the 
back of the throat. If movement of air is 
not established by these methods it is 
necessary to utilize mouth to mouth 
resuscitation or aids such as airways. 
ambu bags or endotracheal equipment. 
2) Circulation: In the event of cardiac 
standstill, external cardiac massage may 
be given. It has been suggested that 
massage be "at about half the normal 
rate" , 3 that is, eight compressions to two 
ventilations every twelve seconds in a 
one man resuscitation. This reduced 
cardiac massage rate is indicated by 
several factors. First, as blood volume 
decreases, a longer period of time is 
required to allow adequate filling of the 
heart chambers. As well, as cell 
metabolism slows, less oxygen is 
required at the cell level and the 
inevitable cardiac irritability prevalent in 
these states may be aggravated by 
aggressive cardiac massage and 
arrhythmias may ensue. 
3 ) General Baseline Data: Data for the 
hypothermia victim should include vital 
signs using deep body temperature,level 
of consciousness, shivering response and 
urinary output. Information from 
laboratory analysis and 
electrocardiograms may also be 
required. The goals of this monitoring 
are to detect early warning signals: to 
establish any reason for deterioration 
and to evaluate response to treatment. 
All data should be recorded immediately 
upon admission and monitored 
frequently during recovery. 
4) Temperature: Deep core body 
temperature may be obtained rectally or 
at the tympanic membrane. A normal 
clinical mercury thermometer is of 
limited use as temperatures below 35 0 C 
are not recorded and deep rectal 
insertion is not possible. Electronic 
probes such as the "Electronic 
Thermometer Modes 43T A. Yellow 
Spring Instrument Company, scale range 
20 0 C (68"F) to 42"C (lOOOF), " facilitate the 
recording of lower temperatures at the 
tympanic membrane. Accurate data is 
provided, but specialized equipment is 
required and skilled personnel must be 
available to place the probe against the 
tympanic membrane and seal off the 
auditory meatus. 
Continual temperature data 
collection is essential as often there is an 
"after drop" of the body core 
temperature when cold blood from the 
periphery reaches central areas. 

_t"...r.A.rwtitAn "'11'.. 

5JBlood Pressure: Frequent monitoring 
and recording of blood pressure will 
detect early warning signals of 
"rewarming shock". Cardiac output is 
reduced with hypothermia and as 
peripheral vessels dilate with rewarming, 
blood pressure may drop further. 4 
6) Shh'ering Response: Shivering base 
line data upon admission of hypothermic 
victims will vary according to the body's 
core temperature and cause of 
hypothermia. Victims of immersion 
hypothermia tend to exhibit less 
shivering than victims of slow exposure 
hypothermia due to their rapid loss of 
body heat and subsequent loss of 
When shivering thermogenesis is 
used as the method of rewarming for 
these victims, ongoing monitoring ofthe 
shivering response should be recorded. 
Some non-shiverers require treatment in 
warm whirlpool baths when shivering 
thermogenesis does not appear to be 
adequately affecting the" after drop" in 
temperature. 5 
7) History: Upon admission, obtain a 
history from family, friends Or 
observers. as treatment management will 
depend on any existing chronic or 
debilitating disorders as well as the cause 
of the hypothermia. Victims of slow 
exposure hypothermia more frequently 
present with mood changes which may 
range from confusion to a state of 
profound aggression. These persons are 
also predisposed to hypovolemia due to 
fluid shifts. 

Rewarming techniques 
Treatment for hypothermia consists of 
rewarming. Three main techniques are 
now being used. 
Central Body Re.....arming by means of 
peritoneal dialysis. hemodialysis or 
cardiopulmonary by-pass. Internal body 
warming reduces the possibilities of 
cardiac arrhythmias and ventricular 
fibrillation, a prime consideration as "a 
heart below 28"C can rarely be 
defibrillated by drug therapy and/or 
electric shock...although the heart does 
seem to have an increased tolerance for 
prolonged fibrillation when hypothermia 
exists... "6 
The primary advantage of this 
technique is that the warmth. with 
resultant vasodilation of vessels, reaches 
the primary organs of the body first. This 
is of major consequence to the heart as it 
attempts to restore a normal cardiac 
output. The heart's own cell metabolism 
increases and thereby generates its own 
increased oxygen demands. However, 
the complexity of core rewarming 
requires constant health team expertise 
and the risk of infection is a constant 


GAI\ ?O 

Active SUiface Rewarming through 
baths or heating pads. Warm baths raise 
body temperature by convection, which 
is the transference of heat by means of 
currents in liquids. Therefore if the bath 
water can be circulated with compressed 
air the effectiveness of the bath is 
increased. Vasoconstriction is relieved 
in peripheral vessels and venous return 
to the heart is increased by means of this 
application of exogenous heat. However 
the sudden return of cold blood to the 
body core areas may precipitate an 
"after drop" in core body temperature, 
which can potentiate the possibility of 
ventricular fibrillation, due to further 
cooling of the myocardium. Excessive 
peripheral vasodilation may be reduced 
if extremities, that is arms and legs, are 
initially kept out of the warm bath. 
This is a very efficient method to 
raise skin temperature. By reducing 
shivering and decreasing cell 
metabolism, the cellular demand for 
oxygen is minimized. Using this 
technique, body temperature is raised 
much more quickly than with core 
temperature rewarming. Water 
temperature should be maintained 
between 40-44 0 C and treatment 
terminated when forehead sweat is 
PassÏ\le SUlface Rewarming, whereby 
bOdy temperature is resfored through 
shivering thermogenesis. Spontaneous 
rewarming or warming by endogenous 
means is simple and can be established in 
or out of an institutional setting. 
Shivering, one of the body's mechanisms 
to increase heat production. in 
combination with insulation by blankets 
to decrease heat loss causes less trauma 
to the patient who is susceptible to 
compliçations such as arrhythmias. 
Spontaneous rewarming is slow and 
for this reason this technique is not 
always the method of choice for treating 
the hypothermic patient who is hypoxic 
and at risk, but for the elderly and 
enfeebled patient who has s]owly 
become hypothermic passive rewarming 
is recommended. " ...In a patient with a 
stable rhythm, whether bradycardia or 
atrial fibrillation, stable vital signs, and 
'near' normal blood gases, passive, 
peripheral rewarming during monitoring 
can be successful... "7 
Victims of accidental hypothermia 
may simulate death. Nurses should 
always remember, however, that there 
have been many reports of successful 
revi vals after one hour of acti ve 
rewarming and supportive care. Death 
should not be a diagnosis unless there is 
a failure to revive after one hour of 
resusciation and rewarming to 30 o C. .., 

ø - 1l8{J1 _ 1 

Clinical Features of the 
Accidental Hypothermia 

Moderate Hypothermia 
(Most frequent) 

cold skin 
irregular pulse 
poorly reactive dilated pupils 
polyuria or oliguria 
muscle rigidity 
altered mental state 

Profound Hypothermia* 

cold skin 
cardiac standstill 
fixed dilated pupils 
no urine output 

*Profound clinical features are 
indistinguishable from death, therefore, 
death may be defined if there is failure 
to revive after one hour of attempted 
resuscitation and core body 
temperature has been raised to 30 o C. 

I Keating. W.R. Accidental 
immersion hypothermia and drowning. 
Practitioner 219: 1310: 184, Aug. 1977. 
2 Ibid.. p. 184. 
3 Ibid..p.185. 
4 O'Keeffe, Kevin, Mo Accidental 
hypothermia: a review of 62 cases. 
JACEP6:11:492. Nov. 1977. 
5 Collis, M.L. Accidental 
hypothermia: an experimental study of 
practical rewarming methods, by MoL. 
Collis et al.Aviat. Space Em'iron.Med. 
48:7:625, Jul. 1977. 
6 Ibid.. p.627. 
7 O'Keeffe, op.cit., p.495. 
8 Ibid., p.495. 

I Allen, E.T. Hypothermia: 
prolonged immersion in cold water. 
Nurs.Mirror 70:50: 1928-]929, Decol2, 
2 Anderson. S. Accidental profound 
hypothermia, by So Anderson et al. 
Brit.JAnaesth. 42:653-655, Jul. 1970. 

Th. Canadl Nur.. 

3 Collis, M.L. Accidental 
hypothermia: an experimental study of 
practical rewarming methods. by MoL. 
Collis et al.Al l iat. Space Em'iron.Med. 
48:7:625-632, Jul. 1977. 
4 Keating, W.R. Accidental 
immersion hypothermia and drowning. 
Practitioner 219: 1310: 183-187, Aug. 
5 Knapman, Y. Nursing care study: 
out in the cold. Nurs.Times 70:2:56-57, 
6 Ledingham, I. Accidental 
hypothermia (letter). by I. Ledingham 
and JoG. Mone.Lancetl:8060:39I, 
7 Mallin, R.E. The Alaska Thermal 
Treatment Centre at Providence 
Hospital. by R. E. Mallin and D.H. 
Addington. Alaska Medo 18:6:79-80, 
Nov. 1976. 
8 Marcus, P. Laboratory comparison 
of technique for rewarming hypothermic 
casualties. A viat. Space Em'iron.Med. 
49:5:692-697, May 19780 
9 Meriwether. W.O. Severe 
accidental hypothermia with survival 
after rapid rewarming. Case report, 
pathophysiology and review of the 
literature, by W.O. Meriwether and 
R.M. Goodman. Amer.J.M ed. 
53:505-510, Oct. 1972. 
10 O'Keeffe, Karen Mo Accidental 
hypothermia: a review of62 cases. 
JACEP 6:11:491-4%, Nov. 1977. 
II Rewarming for accidental 
hypothermia (editorial). Lancet 
] :8058:251-252, Feb. 1978. 
12 Shanks, C.A. Heat gain in the 
treatment of accidental hypothermia. 
Med.J.Aust. 2:9:346-349, Aug.30, 1975. 
13 Stewart, T. Treatment after 
exposure to cold, by T. Stewart and H. 
14 Stine, R.J. Accidental 
hypothermia.JACEP 6:9:413-416, Sep. 
15 Treating accidental hypothermia 
(editorial). Lancet 1:8066:701-702. 

Donna Rae.RN, BScN. is a graduate of 
the Winnipeg General Hospital and the 
U nÏ\lersity of Saskatchewan. After 
sel l eral years ofEmerffency Room 
nursing, she is presently a lecturer with 
the School of Nursing of the University 
ofSasJ...atchewan. Along with her normal 
teaching duties, she has taJ...en part in 
sel l eral Emergency C are Workshops 
throughout Saskatchewan. 


Janet strikes out for a long run on a sunny March 
afternoon. The wind is at her back and Spring is in the 
air. On her return trip, however, the sky has clouded 
over, the M'ind is in her face and her clothes are \l'et with 
perspiration. She is shivering Mtith the cold and }i'onders 
ifshe can make it home... 
Out for a day's cross country ski expedition, your 
companion, who is constantly dieting, begins to 
complain that she is tired and cold, that she }i'ishes she 
had eaten breakfast or brought a snack. By now, you 
are ten milesfrom your car... 
Whether you ski, jog, climb, paddle a canoe or just 
enjoy a peaceful }i'alk in the outdoors, you should be 
aware of hypothermia. Knowing hO}1t to prevent and 
treat both hypothermia andfrostbite makes living in our 
northern climate safer. I nfacl, it COULD save your 

Judith Banning 

N T 
to . .. 

Since hypothellTlia strikes 
quickly and is potentially 
lethal, prevention is obviously 
better than cure. Whether the 
cause is cold (not necessarily 
extreme cold. since problems 
usually occur between 0 0 and 
10 OC) wetness (including fog, 
melting snow, immersion or 
perspiration) or wind, the 
typical victim is exhausted 
and unprepared to protect 
himself. HypothellTlia may be 
a threat in Spring. Summer or 
Fall, not just Winter, so 
persons engaging in outdoor 
activities should always be 
prepared for changing weather 
conditions and be realistic 
about their personal ability to 
cope with the environment. 

Prevention begins with 
recognition of the subtleness 
of cold: 
. Never overestimate your 
strength or ability or that of 
your companions. 
. Dress for changing 
temperatures. wind and wet 
by wearing peelable layers 
which include underwear that 
breathes, does not absorb 
moisture and produces an 
insulating layer ofwallTl air; a 
wool layer and a windproof 
well- ventilated jacket. 



. Always carry an extra 
gallTlent and wear a hat. 
. Remember to carry 
liquids and food, especially 
carbohydrates and stop for 
nourishment frequently, as 
food is a vital source of heat. 
If you feel fatigued, stop and 

The J;a necllen Nur.. 

The first signs of 
hypothellTlia usually include 
shivering and slow or slurred 
speech; you may recognize it 
in yourself, perhaps by 
noticing instances of sloppy 
grammar. Loss of memory 
and confusion may also be 
noted; some victims become 
very obstinate and insist that 
the right direction to take is 
really the opposite to the 
obviously correct one. Often 
at this point, the individual 
cannot be dissuaded. Babbling 
and euphoria are eventually 
followed by stumbling and 
loss of agility, then muscle 
rigidity, loss of alertness and 
eventually unconsciousness. 
As soon as initial signs are 
recognized, efforts must be 
made to prevent further heat 
loss and then to rewallTl the 
victim. The key is to start 
treatment early before 
coordination andjudgment are 

.hnl.rv 1Q1W1 

In an area protected from 
the wind, remove all wet 
clothing and replace with dry. 
Insulate the individual from 
the ground as much as 
possible using branches, 
space blankets, sleeping bags, 
etc. The most efficient method 
of rewarming on the -trail is to 
place the victim nude in a 
sleeping bag with one or two 
rescuers, also nude. A 
hypothermia victim aJone in a 
cold sleeping bag will not 
generate enough heat to 
rewarm himself. If no sleeping 
bag is available, external heat 
may be generated by the 
rescuers huddling around the 
victim. Isometric exercises 
are invaluable at this time as 
little energy is expended and 
activity is maintained. 
If the victim is conscious, 
warm liquids and foods high in 
carbohydrates are indicated. 
However, alcohol should 
never be consumed before or 
during activities in cold or 
variable weather conditions as 
it causes peripheral 
vasodilation, resulting in 
cooling of greater quantities of 
blood 0 
When hypothermia is 
recognized, treatment must be 
initiated immediately and on 
the spot. Attempting to move 
a hypothermic victim to a 
treatment area, if there is a 
chance that the hypothermia 
will progress, is usually futile 
and may end in tragedy. 
Immersion hypothermia, 
occurs much more quickJy 
and leaves little time for 
intervention. If you find 
yourself a victim of immersion 
in cold water, do not remove 
any layers of clothing, they 
will provide insulation. Assess 
the distance to shore before 
deciding to swim: studies have 
shown that an individual will 
cool much faster swimming 
than floating motionless. The 
University of Victoria, in 
studying immersion 
hypothermia, reports a I oC 
drop in temperature for every 
quarter mile the victim swims. 



Since your priorities are to 
remain afloat and to reduce 
heat loss from chest and groin 
areas, treading water is your 
most efficient lifesaving 
technique. If you have a 
personal flotation device. hold 
your arms tight to the sides of 
the chest and your knees tight 
together, then draw your legs 
up towards your abdomen, 
thus rolling yourself into a 
When assisting with the 
rescue of a victim of 
immersion hypothermia, 
follow the steps outlined 
above: that is, remove wet 
clothing (if have no dry 
clothing available. wring out 
wet and reapply especially if 
wool) and prevent further 
cooling. Since in this instance, 
the temperature drops more 
quickly, chances of caring for 
a victim with a temperature as 
low as 30 oC or lower are 
great. In these cases cardiac 
instability must be respected. 
Jostling when moving or 
undressing must be avoided; 
at this stage arrhythmias and 
ventricular fibrillation cause 
most of the fatalities. Even if 
the victim is conscious, he 
must remain inactive for 20 
minutes to one hour after 
rewarming is initiated, since 
after a rescue core 
temperature may drop up to 
three degrees Centrigrade 
with the" after drop" 
phenomenon. This movement 
of cold blood from the 
extremities to the Core and the 
excitable myocardium is 
increased with any activity. 
All submersion victims, 
even if conscious and alert 
should be admitted to an 
observation unit, as statistics 
show 15 per cent of near 
drowning victims who are 
conscious at the time of 
hospital admission die of 
"delayed" drowning from 
pulmonary and cerebral 

Usually, frostbite is restricted 
to the extremities of the body, 
including hands, feet, nose 
and ears, and exposed areas 
such as cheeks and chin. 
Sudden cessation of cold or 
discomfort from a sensitive 
area and perhaps a feeling of 
warmth, often indicate the 
beginnings offrostbite. 
Treatment is determined by 
the depth of tissue affected. 
Superficial frostbite which 
involves only the skin and the 
tissues immediately below, is 
recognized by sudden 
blanching and then a white 
waxy appearance. Usually the 
area will appear frosty and 
frozen on the exterior but 
gentle pressure will reveal 
softness and resilience of the 
tissues below. This type of 
frostbite can be treated 
immediately by rewarming; 
apply steady pressure (no 
rubbing) with a warm hand, 
tuck frostbitten fingers into 
your axilla, or remove boots 
and socks and rewarm toes 
and heels by placing them on 
the abdomen of a companion, 
meanwhile protecting them 
from the wind. 
With rewarming, the area 
will become numb, mottled 
blue or purple and then will 
begin to swell, sting and burn. 
In more severe cases, blisters 
will appear in one to two days 
and will turn black as they dry 
over the next two weeks. 
Aching and burning may 
persist for several weeks and 
once swelling disappears, the 
skin will peel. 
Deep frostbite involves 
the skin, subcutaneous tissue 
and often extends deep into 
the tissue to include the bone. 
In these cases, the injured part 
is hard and solid and cannot 
be depressed. 
Severe cases of frostbite 
should not be rewarmed on 
the trail. A strong individual 
can walk a great distance 
without inflicting further 
injury to a frozen foot, but 
once a frozen part is 
rewarmed, refreezing may 
Occur very quickly. Weight 
therefore should never be 
placed on the rewarmed part 
and an individual whose 
frozen feet or toes are 
rewarmed on the trail is 

The Cenadl.n Nur.e 

automatically reduced to a 
"litter case" - a situation 
which may create a crisis for 
the remainder of the group. 
If a fracture or severe 
sprain occurs in extreme cold, 
the extremity beyond the 
fracture is susceptible to 
frostbite, especially if traction 
is applied. Immobilize the 
fracture with a well padded 
splint, remove shoes or boots 
from the foot below the injury 
and wrap loosely in warm dry 
To rewarm an area with 
deep frostbite, remove all 
clothing from the affected part 
and place in warm water (no 
warmer than 44 OC) or wrap in 
towels and pour warm water 
constantly over the area. Pain 
will increase to a fairly high 
level by the end of the 
rewarming process; this will 
be worse in individuals 
suffering from circulatory 
problems.lfno water is 
available, rewarm with warm 
air, wrap loosely in warm 
blankets or use contact with 
warm human flesh (abdomen 
or ax ilia). Never rewarm by 
exercising, as this will 
increase the extent of the 
iqjury. Never rub the injured 
area at any point during the 
process or afterwards. Never 
rub the frozen area with snow 
or thaw it in cold water, and 
finally, discourage smoking or 
consumption of alcohol. 
Afterrewarming huge 
blisters will develop over the 
next three to seven days and 
the injured area will be 
blue-violet or grey in color. 
Aching. throbbing and 
shooting pains begin about 
day two and persist for two to 
eight weeks. Mobility of the 
affected joints is further 
hampered by swelling of the 
entire extremity; this swelling 
may last up to one month. 
In these cases, 
prevention of infection 
becomes a priority. No 
pressure should be exerted on 
the rewarmed area; expose 
the area as long as it is warm 
or wrap in loose, soft, dry 
dressings. Do not prick or 
break blisters. Passive 
physiotherapy is 

contraindicated as the depth 
of injury is usually difficult to 
assess. However, the 
individual should be 
encouraged to move the 
affected part when possible: a 
whirlpool bath (37 OC) is 
sometimes helpful. Initially 
the injured area should be 
kept horizontal with the bod} , 
changes in elevation may be 
increased with recovery . 

If you want to avoid frostbite, 
keep in mind the following 
. always dress properly for 
outdoor activity 
. ensure an adequate 
intake offoOO for heat 
. avoid tight-fitting 
. avoid dampness (wet 
feet. perspiration, etc.) 
. wear mitts instead of 
. be careful when loading 
cameras or handling metal 
. carry extra socks. mitts. 
etc. and wear two pairs of 
. be aware of windchill 
. do not smoke or consume 
alcohol outdoors 
. remember that previously 
frostbitten areas are extra 
sensitive and subject to the 
cold. ... 

Suggested reading 
I Bange. Cameron. Do's and don'ts 
of immediate treatment. RN 42: II :42-44. 
Nov. 1979. 
2 Baughman, Diane. The frozen 
patient: handle with care. RJ\' 
42:11:38-42, Nov. 1979. 
3 * Kathrop, TheodoreG. 
Hypothermia: killer of the unprepared. 
Mazamas, Oregon, 1975. 
4 Nordic World Editors. Winter 
safety handbook. Mountain View, CA, 
World Pubns., 1975. 
5 *Washbum, Bradford. Frostbite. 
Boston, Boston Museum Science, 1975. 

*Unable to verify in CNA Library 

Hypothermia and the senior citizen 

Fact or fancy: If you or your patient is over 65, you are more susceptible to 
hypothermia than a younger person. (Answer: Fact) 
For many years, public health nurses. in Britain have been aware 
of this problem and hm'e taken steps to overcome it. Now, community 
health nurses in Canada are faced with caseloads that include a 
disproportionate number of elderly individuals subsisting on fixed 
incomes, who hm'e adopted a sedentary lifestyle, eat po()rly, dress 
inadequately and, for the most part, spend their time in quarters that 
are not properly heated. 
As nurses we are programmed to loo/...for ele\'ations in 
temperature; all too frequently we ignore the implications of lower 
temperature readings. Naturally the implications ofhypothermia are 
magnified when paired witl! disease entities such as diabetes or heart 
trouble or with drugs such as anti-psychotics which may potentiate 
hypothermia. It is all too easy, for example,for an elderly person to 
slip on a bit of ice when heJ she steps outside to get the mail or to forget 
to close a door or a window. 
What can we do? As nurses we must be aware of the signs of 
hypothermia and act to identify persons-at-ris/.... We can suggest 
increased layers of clothing, encourage daily exercise, ensure that 
adequate food is available and that the individual is actually eating. 
Remember, a lower thermostat setting means an extra sweater for 
most of us. For the elderly it can spell danger, e\'en death. 



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The Cenøaløn Nurse 


You're in hospital with what? 

Maureen Steen 
Psoriasis. It means different things to 
different people: to the stand-up 
comedian it is cause for reference to the 
'heartbreak of psoriasis' , but to the 
anguished and depressed hospitalized 
psoriasis patient, it means loss of 
self-esteem, loss of self-confidence- 
maybe even the loss of his job. 
This year I found myselfbetween 
these two extremes, hospitalized for 
three w.eeks' treatment of widespread 
psoriasis. The all-too-familiar red itchy 
patches, plaque and endless scales had 
been with me for years, but this year was 
different. After an almost total clearing 
of my skin in the summer, a sudden 
flare-up did not respond to the usual 
corticosteroid treatment. My thighs, anal 
area and scalp were covered with thick 
hard scales, and the guttae. or drop-like 
lesions, covered the rest of me except for 
my face. 
I was, in short, a mess. My 
dermatologist suggested hospitalization 
for the standard treatment which 1 knew 
was messy, uncomfortable and 
time-consuming. How could I get away? 
My job as a public health nurse had 
become particularly demanding since 1 
had taken on the role of team leader: the 
university course 1 was taking was a real 
'heavy' one, and my busy household of 
husband, three teenagers and a dog could 
not do without me for three weeks. 
Thanks, I said, but no thanks. 
The Christmas that followed was 
definitely not merry; shopping, baking 
and mid-term exams left me drained. 
After the holidays I saw my physician 
who prescribed an antidepressant. This 
was both good news and bad news - my 
mood elevated. my skin worsened. A 
drug reaction is spotted a good deal 
sooner in someone with clear skin. By 
the time 1 stopped taking the 
antidepressant 1 had good reason to be 
depressed -I was a swollen, 
uncomfortable, itchy mass of psoriasis. 
More tests showed that the fatigue and 
nausea were not due to nerves, but to a 
problem with liver functiono 
1 was scared. 1 would go into 
hospital 1 decided, but 1 was told it was 
too late...all the dermatology beds were 
1 waited two months for a bed and in 
the meantime dropped my university 
course, and cut my family and social 
obligations to a minimum. 1 still worked 
- my reasoning was that I would just 
feel sorry for myself at home waiting, 
and my doctors agreed - but I was 
penorming at less than my usual 

oa. C


Finally, the call came to go to 
hospital, and 1 learned 1 was to go on the 
Goekerman regime. I This treatment was 
first used at the Mayo clinic 50 years ago 
and is a conservative but messy 
treatment of psoriasis. Basically, it 
in vol ves the use of coal tar ointments, 
coal tar baths and exposure to ultraviolet 
light. The tars are antipruretic and 
antimitotic, but most of all they act to 
increase the photosensitivity of the skin 
so that the ultraviolet light can reach and 
alter the affected cells. 
My routine in hospital was as 

7:00A.M. -Bath in special tar solution 
and shampoo with tar. 
8:00A.M. -Breal..fast. 
9:00 A.M. - Physiotherapy for 
Stripped, I was bakedfor 
increasing periods of time, 
like a chicken on a barbeque 
-now front, sides, back. 

Th_ "'."-.::iIl.'" ....... 10. 


====: = 

10:00 A.M. -First annointing with "the 
goop". This slllffis 
incredible. My room smells 
like railroad ties and I look 
like a coal miner. It stains, 
it smells, but it works! 
Special potions and lotions 
went on scalp and 
peri-anal areas because 
tars are contraindicated in 
these areas where they 
may burn the skin. 
12:30 P.M. - Lunch. 
2:00 P.M. -Reannoint with "goop" .It 
is amaz;n1? how much of this 
stuff wears off. Because of 
this, sheets are not chan1?ed 
daily for the psoriasis 
patient. You .deep in your 
blackened, greasy, scaly 
em'elope for a week. This 
not only sm'es laundry but 
e\'ery time you get into bed 
more tar is rubbed in. 
3:00P.M. -Nap. 
4-6:00 P.M. -Read, listen to radio or 
contemplate blad., 1?reasy 
6:00P.M. -Supper. 
7:00 P.M. - Vi.
itors- "Don't touch me 
- it stains!" 
9-10:00 P.M. - Last tar ointment of the 
day. I put on my 
ointments myself but the 
nurses "do" me where I 
cannot reach. Belie\'e 
me, touch as a therapy 

hould not be 


- . 

PSORIASIS - the disease 

Psoriasis is a chronic recurring skin disease 
that manifests as papulosquamous lesions; 
primary lesions form as papules, and the 
remainder are covered in scales. ' 
Approximately one to three per cent of the 
general population is affected by psoriasis, but 
reporting is inaccurate because minor cases 
often do not seek treatment. Psoriasis occurs 
more frequently in colder climates. and in the 
winter months. 
The cause is unknown. What happens is 
that the DNA in the skin cells is somehow 
programmed to increase the speed of the cell 
cycle so that mitosis. or proliferation of cells, 
occurs much more rapidly than usual. The 
buildup of cells results in the extra skin or 
scales that appear. Koeberization is the 
process by which guttae-type psoriasis 
seems to spread: an abnormal skin reaction 
appears in areas of previously normal skin. 

The purpose is to alter the cell cycle to slow 
proliferation; treatment may be systemic or 

. SteroIds" - mild: 1 0 0 HCI 
- medium: Synalar, Betnovate 
- strong: LJdex, Halog 
. Anthralm 
. Tars. coal tar ointment'. Estarjel 
. Ultraviolet light alone 
. UV light with tar (Goekerman regime) 
. UV light with Ar.thralin (Ingram regime) 

. steroids 
. Methotrexate 7 - this drug is a folic acid 
antagonist which reduces the amount of DNA 
available to epidermal cells; because it inhibits 
cell growth it is commonly used to treat 
malignancies, and is a powerful 
immunosuppressant. The drug has many side 
effects (see CPS) especially impaired liver 
function. and IS used only in patients with 
severe psoriasis who are being monitored. 
. PUV A" - Psoralen taken in conjunction 
with UV light treatments. Methoxsalen, a 
photosensitizer, is taken two hours before light 
therapy, and helps to disrupt DNA replication. 
Side effects include premature aging of the 
skin and opthalmic problems. 

.It should be noted that in animal studies, coal 
tar skin treatments have been found to be 
carcinogenic: in human use however, the 
benefits gained by tar treatments for psoriasis 
patients are thought to outweigh the risk of 
skin cancer." 

When one's 'body image' is such 
that one is repulsed by his or her own 
appearance, acceptance by another is 
wondeñul. There is little time for nurses 
on any busy medical floor to stop and 
chat, but I did appreciate the few times 
anyone did. 
Amazingly, I could see and feel real 
progress; the slight sunburn from the 
light was uncomfortable but never 
actually painful. 
There are many misconceptions 
about psoriasis: even some of my 
colleagues were skeptical about the 
length of my treatment, although, on the 
whole, I found the hospital statTvery 
understanding. The most serious 
misconception is that psoriasis is caused 
by 'nerves'. In a study done by Drs. 
Sobel and Baughtom, 2 the role of stres
and emotional factors was demonstrated 
to be not a casual one; however, the real 
question that arose was, which comes 
first. the disease or the stress? Yet 
another study of some 5600 psoriasis 
patients examined over a period of ten 
years failed to identify a particular 
psoriasis personality type. 3 
This is not to 
ay that the severity of 
psoriasis does not vary with life stresses, 
but that stress is only one of several 
factors that serve to trigger the disease 
process. Others include infection
trauma, and drug reactions. 
Day care facilities for psoriasis 
treatments are becoming increasingJy 
popular. Various methods have been 
employed but some medical researchers 
emphasize the importance of group 
therapy as part of the overall treatment.. 
Psoriasis remains an enigma- 
chronic, persistent and resistant to 
treatment. Research has failed to 
discover what causes psoriasis although 
heredity seems to be important: while 
new pharmaceuticals and new methods 
of treatment are being developed 
psoriasis patiemsjust have to learn to 
live with their affliction. For the nurse, it 
is important to be aware of the deep 
psychological effects of this disease. 
especially for teenage patients. A little 
acceptance, support and understanding 
can go a long way. 
For myself. my hospital stay has 
given me a reprieve, a temporary 'cure'; 
I know that I have but to live one 
itch-free day at a time. ... 

I Farber. Eugene M. Hospital 
treatment of psoriasis. A modified 
anthralin program, by Eugene M. Farber 
andD.R. Harris.Arch.Derm. 
101:381-389, Apr. 1970. 
2 Farber, Eugene M. Emotional 
factors in psoriasis. recent findings, by 
Eugene M. Farber and Alvin Cox. (In 
International symposium, 2nd. Psoriasis: 
proceedings. Eugene M. Farber and 
Alvin Cox, eds. New York, Yorke 
Medical Books. 1977.) p.180-188. 

Th ,. _ "'1_ 

3 Farber, Eugene M. The natural 
history of psoriasis in 5,600 patients, by 
Eugene M. Farber et al. Dermatologica 
4 Cram, DoL. Psoriasis day care 
centres, byD.L. Cram and R.J. King. 
JAMA 235:2: 177-178, Jan. 12, 19760 
5 Loose Leaf Reference Services. 
Clinical dermatology. Joseph D. Demis 
et al. eds. New York. Harper Row, 1974. 
Vol. I, Unit 1-2, p.1-4. 
6 MacKenzie, A.W. Topical 
therapy, by A.W. MacKenzie andD.S. 
Wilkinson. (In Rook, Arthur. Recent 
advances in dermatology, no.4. New 
York, Churchill Livingstone, 1977.) 
7 Roenich, Henry H. Methotrexate, 
where are we today? (/ n International 
symposium on psoriasis, Stanford 
University, 1971. Psoriasis: proceedings. 
Eugene M. Farber and Alvin Cox, eds. 
Stanford,CA, Stanford Univ. Press, 
8 Van Scott, Eugene. Therapy of 
psoriasis, 1975.JAMA 235:2:197-198, 
Jan. 12, 1976. 
9 Ibid. 

I *Br.J.Dermatol. 70:139-145,1958. 
2 Goodwin. P. The cell cycle in 
psoriasis, by P. Goodwin et al. 
Br.J.Dermatol. 90:517-524, May 1974. 
3 Manicelli. Mario. Koebner 
reaction in psoriasis.(ln International 
symposium on psoriasis, Stanford 
University, 1971. Psoriasis: proceedings. 
Eugene M. Farber and Alvin Cox, eds. 
Stanford, CA, Stanford Univ. Press, 
4 Miller. Benjamin F. Encyclopedia 
and dictionary of medicine and nursin1?, 
by Benjamin F. Miller and Claire B. 
Keane. Toronto, Saunders, 1972. 
5 Moschella, Samuel. DermatoloRY, 
by Samuel Moschella et al. 1st ed_ 
Toronto. Saunders. 1975. Vol. I., pA24. 

*U nable to verify in CN A Library 

Maureen Steen,RN. is a graduate of the 
St. Joseph's School of Nursing, Hôtel 
Dieu Hospital, Kingston, Ontario; she 
has a diploma in public health nursing 
from the Unil'ersity of Ottawa , a 
diploma in Family Life Education from 
Algonquin College, and is currently 
compl etinR a B .A. degree in psvchology 
at Carleton University. Steen has 
wor/..edfor the past nine years as a PHN 
with the Ottawa-Carleton ReRiollal 
Health Unit. 

ledgement: The author gratefully 
ac/..nowledges the assistance of the staff 
of the Dr. CoS. Williamsoll Medical 
Library, Ottawa Cil'ic Hospital ami Dr. 
layerqfOttawa, in the 
preparation oft/lis article. 


The Psoriasis Education and Research 
Centre located in Toronto is a unique 
facility in Canada. It was developed 
expressly for the purpose of education, 
research and the treatment of patients 
with psoriasis. Affiliated with the 
Women's College Hospital and the 
University of Toronto , underthe 
direction of Dr. R.K. Schachter, the 
center is staffed by a nurse-coordinator, 
2 RNA's, a secretary, a medical 
photographer and research personnel as 
well as a staff dermatologist. 
The center (PERC) is a day hospital 
which operates from Monday to Friday 
in two' shifts': 0800 to 1600 hours, and 
1300 to 2100 hours. This arrangement 
allows patients to continue with their 
regular work, family and social patterns 
as much as possible. The center has been 
able to treat the average patient for 
approximately one-third ofthe cost of 
inpatient hospitalization. 

Along with the program of active 
treatment, the staff at PERC has 
organized a three-part education 
program for patients. 

c ..
.. , .ø_n 


the selective alternative for 
psoriasis patients 

Margaret Burns 

R.K. Schachter 

Any patient who attends the center must 
be referred by a dermatologist or family 
doctor; everyone referred is assessed 
initially by the staff dermatologist and a 
decision is made about treatment at that 
time. There are two types of psoriasis 
that cannot be treated in a day hospital 
-erythroderma and generalized pustular 


The patients' treatment regimen is 
for three weeks' duration and they may 
attend either the morning or the 
afternoon session, whichever is most 
convenient for them. 
A typical routine includes: tar bath. 
tar shampoo, ultraviolet light, 
application of medications and an 
education sessiono After a lunch break, 
medications are re-applied, followed by a 
relaxation hour and then removal of 
medication, tar bath and tar shampoo. 

______ T h_ r .... ... .,. .._ 

During the three weeks, the patients 
are seen regularly by the dermatologist 
who assesses their progress and looks 
after any treatment problems. 

A unique facet of PERC is the 
individualized education program, the 
goal of which is to help patients learn 
about psoriasis, self-care and means of 
coping with stress. In a large center like 
Toronto, our patients come from a wide 
range of backgrounds, and we try to 
tailor each patient's program to his or her 
individual requirements. 



To do this. the nurses use a detailed 
history and interview form to aid in 
assessing the patients' knowledge of the 
condition. and how well each person has 
been coping with his diagnosis. By 
analyzing the infonnation, it is possible 
to outline each patient's specific 
educational needs. Basically the program 
consists of discussion in several areas. 

The pathophysiology of psoriasis is 
explained, along with factors that may 
aggravate the condition. and an overview 
of present-day therapy. A phannacist 
gives a session on both the prescription 
and proprietary (over-the-counter) drugs 
that are used in psoriasis treatment. 
discussing drug action and possible 'iide 
effects. Instruction is given regarding 
proper use of the drugs most commonly 
A yoga class is held weekly to 
provide patients with a means to relax. 

A dennatologist conducts an 
infonnal question and answer session. 
which gives the patients an opportunity 
to ask a doctor any questions about 
psoriasis that may occur to them during 
their treatment. Small infonnal groups 
are organized periodically throughout 
the treatment schedule. led by the 
nurses, which aim to increase the 
patients' independence and ability to 
care for themselves at home 0 Good 
general health promotion is stressed. and 
community resources available to the 
patients are discussed. along with any 
subjects that may come up. 

A physiotherapy session 
demonstrates exercises that can be used 
as part of a program for good general 
health, and an occupational therapist 
sees patients individually about lifestyle 
An important part of the group 
sessions is discussion of the role stress 
plays in each individual's home. work 
and social life, and patients are 
encouraged to discuss openly the 
problems they encounter because of 
their psoriasis. Commonly discussed is 
the sense of frustration many patients 
feel as well as embarrassment, due in 
part to the fact that the general public has 
been poorly educated about this chronic 
skin disease. 
Family members are included in the 
educational sessions and they are shown 
how to apply the medications. 



The nurses at PERC assist in the ongoing 
research by aiding in the collection of 
data and participating in the clinical trials 
evaluating effectiveness of new drugs 
and modes of treatment. Research 
meetings are held regularly to discuss 
research and the plans for future 



::" 1; { 

I\I ø \ I 
" ("I 
.' :it:' \) 


More than skin deep 
Work at the Psoriasis Centre is 
very satisfying and rewarding for the 
nursing staff: looking after patients' 
physical and emotional needs is a very 
challenging experience. When patients 
are admitted we see how low their 
self-esteem is. and how they need 
support and encouragement. It is our job 
to gain their confidence in three short 
weeks and to watch them as their 
outlook on life and their self-image 
changes. for the better.... 

Acknowledgement: The authors wÙh to 
adnowledge the help of Liz Rosenberg, 
research co-ordinator. GI}nis Sheppard, 
librarian and Peter \loorefor his 
 go to the Atkinson 
Foundation, National Health and 
Welfare, and Women's College Hospital 
for financial assi.Hance to the Centre. 

I Baughman, Richardo Psoriasis, 
stress and strain, by Richard Baughman 
and R. SobeI.Arch.Dermatol. 
103:599-605, Jun. 1971. 
2 Hodge. L.D. Psoriasis: current 
concepts in management. by L.D. 
Hodge and J.S Camaish. Drugs 
13:4:288-2%, Apr. 1977. 
3 Holgate. M.C. The age-of-onset of 
psoriasis and the relationship to parental 
psoriasis. Br.J.Dermatol. 92:4:443-448. 
Apr. 1975. 
4 Moschella, Samuel. Dermatology, 
by Samuel Moschella et aI. 1st ed, 
Toronto. Saunders, 1975.2 vols_ 
5 Seville, R.H. Psoriasis and stress. 
II. Br.J.Dermatol. 98:2:151-153, Feb. 

caring for a patient with 

- - - - - -- 
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- -- -- -- - - - - - - 

- --- --- 
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How do nurses cope with a patient who just gets worse in spite of everything that's done? A group of nurses in Moose 
Factory found they had no choice but to organize themselves to give the best possible care to their patient, to give as 
much of themselves as possible, and to hope. 

Roberra Ronavne 

Nursing in a small northern Ontario 
hospital means caring for Cree Indian 
and Inuit patients whose culture. 
lifestyle and language are foreign to 
nurses educated in southern Canada. 
Because of the distance from large urban 
centers. most of the medical and nursing 
staff is generally in Moose Factory on a 
short term basis, but this does not 
prevent the formation of close bonds 
between staff and patients, re'\ulting in a 
greater understanding of the culture of 
northern peoples. Such was the case 
with Mrs. K. 
Mrs. K., a 56-year-old Cree Indian. 
was admitted to hospital in the Fall with 
a diagnosis of abdominal pain and 
pneumonia. She appeared pale. thin, and 
in considerable discomfort, finding 
difficulty even in walking. 
We knew from previous admissions 
to our surgical unit that Mrs. K. had been 
an insulin-controlled diabetic for 20 
years, that she had a history of 
congestive heart failure and vascular 
insufficiency which had resulted in a 
below-the-knee amputation, and that she 
had received a full course of radiation 
more than two years ago for Stage II 
carcinoma of the cervix. 
Just prior to admission, Mrs. 1\... had 
been living at home caring for her family 
and her aged ill mother: she had been in a 
great deal of pain, receiving analgesia 
parenterally on visits from her physician, 
while her condition worsened. 
At first, we assumed Mrs. K. was a 
terminally ill cancer patient and prepared 
to support her towards a peaceful and 
dignified death, but lhis was not to be the 
case. Mrs. K. 's symptoms. which 
included a low grade fever, elevated 
WBC, nausea, vomiting and abdominal 
pain, necessitated a small bowel x-ray 
series which revealed a bowel 
obstruction requiring surgical treatment. 

During Mrs. K.'s first surgical procedure 
2 1/2 feet of small bowel were removed 
because of an obstruction due to the 
effects of radiation enteritis: adhesions 
between the omentum and the bowel as 
well as necrosis were found at the 
junction of the ileum and jejunum. The 
remainder of the bowel showed some 
effects of radiation. along with an 
inflamed peritoneum and a distended 
gallbladder. There was, however, no 
evidence of pelvic metastesis. 
Following major surgery, Mrs. K. 
required intensive nursing care. We 
organized our priorities into the 
following headings: 
. nutrition and fluid balance 
. relief of pain 
. psychological support 
. infection control. 

Photo counesy of Health and Welfare Canada 

Nutritional fluid balance 
When Mrs. K. had first been admitted to 
hospital she was on a regular diet, able to 
choose foods she liked to eat: her 
diabetes was controlled by daily 
injections of Lente insulin. 
Post-operatively, Mrs. K. was on 
intravenous therapy with naso-gastric 
drainage and her Lente insulin was 
discontinued. replaced by p.r.n. doses of 
Regular insulin, to be given according to 
doctor's orders after urine testing. 
Monitoring Mrs. K.'s electrolyte 
balance was a medical priority, and 
unfortunately at this time, our laboratory 
machinery was malfunctioning. Blood 
samples for chemistry had to be sent to 
another hospital on a 
regularly-scheduled airplane flight, and 
the results were phoned back to us the 
same day. Although inconvenient, this 
was effective until our equipment was 


Based on the electrolyte results, the 
doctors ordered potassium supplements 
for Mrs. K. 's I.V. solutions: she did not 
do well however, and developed 
post-operative diarrhea (due to 
prolonged antibiotic therapy), nausea 
and vomiting. The doctors treated her 
with anti-emetics. but Mrs. K. lost 
weight rapidly, until she had lost a total 
of 16.2 kg in five weeks. 

Pain relief 
Mrs. K. had been living with pain for a 
long time. but after surgery her need for 
analgesia increased. The nurses were 
alert to non-verbal signs of the need for 
medication in the patient's behavior such 
as rubbing her abdomen and guarding, as 
well as more obvious signs such as 
moaning. As the need for relief of pain 
increased further, recognizing the 
patient's need became less of a problem 
than locating sites for injection. Mrs. K. 
was already receiving anti-emetics 
intramuscularly. and injections of insulin 
subcutaneously. and with her muscle 
wasting and peripheral vascular disease. 
the choice of sites was limited. There 
was the question too of the degree of 
absorption of medication; within a few 
weeks, the patient was started on 
intravenous analgesia. 
Noting the exacl location and 
severity of Mrs. K. 's pain was of great 
importance post-operatively. as It 
became obvious after her first surgery 
that she had developed more problems. 

Infection control 
With a history of diabetes and 
pneumonia. the prevention of infection 
was an important priority in nursing 
care. On admission we had instituted a 
routine of chest physiotherapy to be 
done q4h which was primarily deep 
breathing and coughing. and use of an 
inspirometer. Post-operatively. she WdS 
treated with intravenous broad-spectrum 
Pre-operative infection control 
measures used on our unit are the 
standard Phi soH ex !Ð baths twice daily for 
48 hours pre-op and washing hair the 
night before surgery. 
At the time of surgery. Mrs. K.'s 
WBC had fallen to within normal limits, 
and remained so for several week<; 
post-operatively. Wound cultures taken 
in theO.R. were negative. as were 
subsequent cl:lltures of drainage during 
the early post-operative period. 

Psychological support 
During "freeze-up" when boats can no 
longer be used. Mrs. K. was isolated 
from her family as the ice was not safe to 
carry motorized vehicles to our island 
hospital. Once the ice had frozen !lolid. 
however. Mrs. K. 's daughters arrived 
and stayed in constant attendance for the 
entire period of her hospitalization. 

language differences posed 
problems for the nursing staff in that 
none but the ward aides and secretaries 
on the unit spoke Cree. Mrs. 1\.. did 
speak and understand some English, but 
to ensure accurate transfer of 
information we often used an interpreter. 
Mrs. K. offered little spontaneous 
communication, however. and she 
seldom complained of anything - not 
the pain she had constantly, nor the 
nausea nor the diarrhea. Even when we 
knew she was in pain and asked about it, 
she would not answer "yes", so it 
became a challenge to anticipate her 
We tried to keep her and her family 
informed about her progress, and to 
prepare her for the various tests and 
A grand-daughter was hospitalized 
for a time and we ensured family contact 
by wheeling Mrs. K. out to the ward 
phone as often as she desired it. 
We encouraged independence too 
by gradually giving her more 
responsibility in her own care - bathing. 
feeding and putting on her leg prosthesis. 

It became increasingly obvious in the 
post-operative period that Mrs. K. was 
not improving: her abdominal pain was 
worsening, her nausea and vomiting 
persisted, she exhibited abdominal 
distention, and her wound issued 
purulent drainage. A fluid diet was 
started but wa!l not tolerated. She was 
scheduled for a second laparotomy in 
which another 2 1/2 feet of bowel was 
resected. The bowel showed ischemic 
necrosis of the jejunum as a result of 
vascular occlusion in the terminal 
portion of the superior mesenteric 
artery. A cholecystectomy was 
performed at this time as the 
inflammation and distention seen in the 
gaJlbladder in the first surgery had not 
After surgery Mrs. K. required 
constant nursing care. which meant- 
since our ward staff was comprised of 4 
RN's. I RN A and several aides - totally 
readjusting the time schedule to provide 
adequate care. As it happened. several of 
the nurses were anxious to see that 
constant quality care was provided, and 
so worked double shifts or extra hours. 
Medical priorities at this time were 
the prevention of further vascular 
occlusion through heparin therapy, low 
doses parenterally ql2h, and 
maintenance of a good nutritional state 
through Total Parenteral Nutrition 
(TPN) or hyperalimentation. consisting 
of 10 per cent Travesol and I ntralipid 
solutions. This was to be given Mrs. K. 
intravenou!lly through catheter inserted 
in an antecubital cutdown site. 

For the nursing stafTwho were 
unfamiliar with such things as 
hyperalimentation and the mixing of the 
special solutions. this was a time of great 
anxiety. We had to arrange therefore a 
special inservice program to deal with 
the basics ofTPN and the nursing care 
involved. In order to ensure adequate 
flow rates of the intravenous infusion, 
infusion pumps were used, and the use of 
these mechanisms had also to be taught 
to the nurses. 
We had the same basic priorities in 
organizing Mrs. K.'s nursing care, but 
due to the seriousness of her condition at 
this time. tasks were more complex than 

Nutrition andfiuid balance 
Oral intake was obviously impossible 
and so Mrs. K. was on total parenteral 
nutrition: she also had a straight 
intravenous line for antibiotic therapy. 
Both were aided by the use of infusion 
pumps. Nursing responsibilities at this 
time included maintenance of flow rates 
and mixing of the I.V. solutions. Of no 
small importance too was the charting of 
intake and output, monitoring of tube 
drainage, results of urine testing, and 
laboratory results such as Hgb, 
electrolytes. Bl'N and glucose levels. 

Infection control 
Due to Mrs. K.'s debilitated condition 
and diabetes, infection was an 
ever-looming problem. The patient was 
maintained on strict isolation of 
dressings and bedlinens, and her wound 
dressings which were changed nearly 

PsvcllOlogical support 
As her condition worsened and her pain 
increased, Mrs. 1\.. became convinced 
she would never recovero She asked to 
receive the last rites of the Catholic 
church, which we arranged, and she was 
permitted to have her family nearby as 
much as possible. 
It was a difficult time for the nurses: 
they cared very much for their patient, 
and yet they had to cope with continually 
changing doctor's orders, and the 
evidence that Mrs. K. was in fact not 
improving. It was difficult for them to 
adopt a supportive positive attitude with 
Mrs. K. and her family when it was 
apparent to all that her wound was not 
healing, that her nutritional status 
remained poor, and that she could not 
get full relieffrom her pain. 
The situation became still worse 
when. 48 hours after surgery, the doctors 
decided she must return to the O.R. for 
yet a third time for surgical debridement 
of an infected wound: the wound swabs 
had shown the presence of clostridium 
perfringens, pseudomonas and E. Coli. 
The surgeon was available at our hospital 
in Moose Factory only two or three days 

a week, and to attend to Mrs. K. the 
hospital had to arrange for a chartered 
plane to bring him from his home base. 
The doctors agreed that Mrs. K. would 
be better in a hospital in the South, under 
the circumstances, and planned a 
transfer for her post-operatively. 

Pre-operatively, we notified Mrs. K. 's 
family, and the priest; the doctors 
explained to Mrs. K. with her family 
both the necessity and the risks of the 
proposed surgery. The nurses wanted to 
offer as much support as possible; we 
were able to arrange a room for the 
family to sleep in until after the 
The final surgery involved 
debridement of the wound and further 
bowel resection necessitating an 
ileostomy, and Mrs. K. returned to the 
unit with numerous drainage tubes - 
N/G, Foley catheter, duodenostomy and 
multiple abdominal drains - as well as a 
subclavian intravenous line. She was 
also on oxygen by masko 

Our priorities were as before: to 
prevent infection by maintenance of 
strict isolation technique (which was 
difficult to accomplish while allowing her 
family liberal visiting privileges, and with 
the large numbers of medical and nursing 
staff in attendance), good 5kin care. 
relieffrom pain, nutrition and emotional 
The next development was 
disheanening: Mrs. K. had a myocardial 
infarction post-operatively and went into 
congestive heart failure. In spite of the 
obvious negative aspect of this 
development, Mrs. K. was actually 
pleased because it meant her condition 
was too serious to allow her to be 
transferred to a hospital in southern 
Ontario as the doctors wished; the family 
unit in Cree culture is often very close, 
and Mrs. 1\.. did not want to leave those 
who were closest to her. 
Psychologically, she was prepared to 
die, and fought the sedatives and 
analgesia to remain alerto She rejected 
our constant care, saying that we were 
"waiting for her to die" . 

And it was true, Mrs. K.'s prognosis 
was grave: her white count rose to over 
40,OOO/cu mm, her congestive heart 
failure worsened, and she developed 
frequent paroxysmal ventricular 
contractions and had diminished 
response to stimuli. 
Seven weeks after her admission she 
For the nursing staff, her death, 
though inevitable, was a great 
disappointment; they had come to know 
Mrs. K. and her family so well, and had 
learned a great deal about the Cree 
people and their culture. We all felt we 
had participated actively, giving as much 
as we could, to help Mrs. K. in her battle 
against the insurmountable odds of 
diabetes, heart disease and radiation 
enterilis. ... 


The goal of radiation therapy is to destroy malignant cells without unduly harming the 
surrounding tissues. 
Adverse reactions are influenced by: 
. intensity of prescribed dose and degree of exposure: exposure to greater amounts of 
radiation may cause necrosis of intestine, malabsorption, intestinal obstruction and 
. radiosensitivity of cells: most radiosensitive cells are 
a) rapidly dividing 
b) poorly differentiated, embryonic, immature 
c) have increased metabolic activity. 
. individual differences: the rate of injury increases in the presence of pre-existing 
vascular disease, diabetes mellitus. arteriosclerosis. hypertension or existence of past 
injury to the intestinal tract. 
Specific G.). effects of radiation: 
. jejunal and ileal injuries are evidenced by crampy periumbilical pain, nausea, 
vomiting, abdominal distention and obstipation; 
. pathological lesions are usually ulcers which may bleed. perforate and stenose. 
Symptoms are malabsorption, acute and chronic obstruction, abdominal pain. 

I American Hospital Association. 
Committee on Infections within 
H ospitals./ nfection Control in the 
Hospital. 3d ed., Chicago,ll1. 1974. 
2 Luckmann. Joan. Medical-surgical 
nursing: a psychophysiologic approach, 
by Joan Luckmann and Karen C. 
Sorenson. Toronto, Saunders, 1974. 
3 Meakins, J.L Pathophysiologic 
determinants and prediction of sepsis. 
Surg. Clin. North Amer. 56:4:847-857, 
Aug. 1976. 

.an r

4 Sabiston. D.C. Dadd-Christopher 
textbook of surgery. VoL!. 10th ed. 
Toronto, Saunders, 1972. 
5 Schmitz. R.L Intestinal injuries 
incidental to irradiation of carcinoma of 
the cervix of the uterus.. by R. L Schmitz 
et al. Surg.Gynecol.Gbstet. 138:29-32, 
Jan. 1974. 

Tha ,.............. ".area 

At the time this article was written 
Roberta Ronayne,RN, BScN, was head 
nurse on the surgical unit at the Mome 
Factory General Hospital. She is a 
gradullte of the Ottawa Ci\'Ïc Hospital 
and the University of Ottawa; she has 
returned to Ottawa and 1I0W teaches 

Acknowledgment: The author would Ii/...e 
to thallk Dr. D. Allanfor his assistance ill 
the preparation of this article. 

Antidiuretic Hormone and its 
Inappropriate Secretion 


Mr. Fisher was admitted to the neurological unit with a diagnosis of head 
injury; he is irritable and complaining of a headache. Mrs. King had major 
abdominal surgery three days ago; she is lethargic and anorexic. These two 
apparently normal reactions to two obviously different causes are, in effect, 
responses to the Syndrome of Inappropriate Antidiuretic Hormone 
Long thought of as a hormonal imbalance that only concerned 
neurological personnel, this syndrome is now being recognized as playing a 
very important role in many other conditions. Malignancies, especially 
involving the lungs, anesthetics, stress and pain have all been associated 
with an overproduction of this hormone. 
Muriel Burry Lydia Martens 

Antidiuretic hormone (vasopressin) 
regulates the body's fluid balance by 
altering the permeability of the renal 
tubules and affecting water reabsorption 
rates. This hormone, which is made up of 
eight amino acids, is synthesized in the 
supraoptic nuclei of the hypothalamus 
(See figure one). It is then transpor1ed 
through the hypophysial stalk to the 
posteriorlobe of the pituitary gland 
where it is stored and eventually 

Osmoreceptors located in the 
hypothalamus control the synthesis and 
release of antidiuretic hormone (ADH). 
These receptors, which are sensitive to 
the concentration of the plasma are 
assured an excellent blood supply by the 
hypothalamic ar1ery which arises from 
the Circle of Willis. Thus, each minute 
change in osmolality is readily available 
to the osmoreceptors. (Osmolality is the 
measurement of the solute concentration 
per liter of solution.) 

Th,.. '"__........_ ....___ 

The normal stimulus for the 
production of ADH is an increase in 
plasma osmolality, such as in 
dehydration. The osmoreceptors 
stimulate the supraoptic nuclei to 
increase synthesis of the hormone and to 
transmit impulses to the posterior 
pituitary to release appropriate amounts 
of ADH. The hormone enters the general 
circulation by way of the inferior 
hypophysial vein and is carried to the 
kidneys where its potency is realized. 

In the distal convoluted tubules of 
the kidneys, ADH increases the tubules' 
penneability to water, allowing a greater 
reabsorption to take place, thus diluting 
body fluids. With this dilution, plasma 
osmolality is decreased and 
osmoreceptors signal the hypothalamus 
to reduce the production and release of 
ADH levels are also influenced by 
baroreceptors in the left atrium of the 
heart which respond to changes in blood 
pressure. In the event of hypovolemia, 
ADH secretion is increased and body 
fluids conserved through the increased 
reabsorption of water. Baroreceptor 
response may also be influenced by 
one's position: an unconscious patient 
being nursed supine tends to have high 
serum levels of ADH because of 
inadequate atrial filling. This same 
stimulation may also occur when 
positive pressure breathing is being used 
and conversely ADH levels may 
decrease with negative pressure 

Syndrome of Inappropriate Antidiuretic 
Hormone Secretion 
Although ADH is normally secreted in 
response to stimulation by plasma 
osmolality there are times when there is 
an excess produced without this 
stimulus. This pathophysiological state is 
tenned Syndrome of Inappropriate ADH 
Causes are both inÜacranial and 
extracranial. ranging from neurological 
disorders that produce cerebral edema, 
to malignant diseases. particularly of the 
lung if the tumor secretes a substance 
similar to ADH, and to pharmaceutical 
agents such as anesthetics, morphine and 
chlorpropamide (Diabinese1\!). Because 
of the wide variety of causes, the 
syndrome is not always recognized until 
it is fairly well advanced. 
Since S.LA.D.H. occurs when the 
serum osmolality is normal (280-295 
mOsm/kg), the increase in ADH which 
stimulates an increase in the amount of 
circulating body fluid results in a relative 
hyponatraemia (normal serum sodium is 
135-145 mEq/l) and a reduction in urine 
volume, as low as 400 ml/day. This 
phenomenon is commonly tenned "salt 
wasting" as the body responds to the 
increased blood volume by reabsorbing 
less sodium through the renal tubules. 

The diagnosis of S.LAD.H. rests on the 
combination of a low serum sodium and 
osmolality with d high urine sodium 
(normal is 27-287 mEq/24 hr) and a urine 
osmolality greater than that of the serum 
This relationship must exist in the 
presence of a normal blood urea nitrogen 
and creatinine. 
Mild hyponatraemia (120 mEq/l) 
causes lethargy, irritability, anorexia and 
headache. If this is not corrected, the 

 JAlvuarv JJIIIIl 

hyponatraemia becomes severe (110 
mEq/l) and nausea, vomiting and 
confusion may lead to convulsions, coma 
and death. Cardiac fibrillation becomes a 
very real threat. 

Fluid restriction, the principal treatment 
of this syndrome, usually corrects the 
hyponatraemia within seven days. 
However. as fl.uids are given oruy to 
make up insensible fluid loss, a restricted 
intake of 500-800 mls/24 hrs is distressing 
to the patient and family who may not 
fully comprehend the reasons for the 
regime. Chronic conditions of 
S.LA.D.H. such as inoperable 
malignancy of the lung, magnify these 
Two drugs have been used to relieve 
the necessity of fluid restriction. Lithium 
Carbonate, an anti-manic medication, 
has a side effect of producing a 
nephrogenic diabetes insipidus. This 
drug seems to interfere with the ADH in 
the distal tubules, causing a water loss 
and a sodium retention secondary to 
increased aldosterone. The 
recommended dosage is 900 mg/24 hrs in 
divided doses. However, many 
sometimes hannful side effects may be 
experienced, such as digestive upsets, 
cardiac arrhythmias, peripheral 
circulatory collapse, diffuse thyroid 
enlargement and central nervous system 
irritation including dizziness, drowsiness 
and seizures. lithium is considered to be 
effective oruy on a short term basis as 
with prolonged use it seems to interfere 
with the action of aldosterone, resulting 
in further sodium loss. Consequently it is 
not useful in the treatment of chronic 
De methylchlortet racycl ine 
(demeclocycline) 300 mg, four times 
daily, has been reported to cause a 
reversible decrease in renal urinary 
concentrating ability and thus increases 
water excretion and resolves the 
hyponatraemia, again producing a 
nephrogenic diabetes insipidus. 
Effectiveness of demeclocycline is noted 
only after several days oftreatment, but 
few side effects, such as nausea and 
photosensitivity, are produced. As a 
result, it is used most frequently with 
chronic S.I.A.D.H. 
Ifhyponatraemia is so pronounced 
that the central nervous system is 
affected, an initial treatment of 
intravenous hypertonic saline may be 
given in an attempt to reduce cellular 
swelling which could cause irreversible 
cerebral damage. Usually, 500 mls of five 
percent sodium chloride is given. The 
rate should not exceed 75 mIs/hour and 
50 to 60 mIs/hour is considered optimum. 
As the plasma volume is increased, the 
proximal tubules of the kidney excrete 
the sodium so that there is no long term 
effect to be derived from this method of 

The CalWdla.n Nuru 

treatment. Lasix
 (furosemide) may also 
be given at this time to induce a rapid 

Nursing responsibilities 
. Monitoring offluid balance: Intake, 
output and specific gravity of urine 
should be measured for all patients with 
cranial disorders in order to detect this 
syndrome in its early stages. 
Once a diagnosis ofS.I.A.D.H. has 
been made, fluid restriction assumes 
ultimate importance. Fluids should be 
allocated throughout the twenty-four 
hours, taking into account medication 
regimes; giving pills with meals allows 
fluid rations to be more flexible. Good 
mouth care and frequent mouthwashes 
help to alleviate thirst but confused 
patients must be observed carefully as 
they may swallow the mouthwash 
While body fluids are being 
retained, urine volume and specific 
gravity are essential measurements; the 
specific gravity will be high (1.025) and 
volume low. Fluid retention is also 
indicated by daily weight gains that are 
out of proportion with caloric and fluid 
intake. Although restless head-injured 
patients present problems with daily 
weighing, this measurement is essential 
to determine if changes in cerebral 
function are being caused by the disease 
or injury or by an electrolyte imbalance. 
. C ol/ection of specimens: Serum and 
urinary electrolyte and osmolality 
measurements must be taken on a daily 
basis. The diagnosis is detennined from 
these levels and the response to 
treatment is monitored in the same way. 
Collection of specimens, recording of 
results, awareness ofnonnal values and 
significance of variations are all nursing 
. Administration of medications: 
Intravenous hypertonic saline with or 
without Lasix@ may be ordered at the 
critical stage of fluid retention to prevent 
cerebral damage. Once an initial diuresis 
has been achieved, treatment may be 
continued with lithium or 
demeclocycline. (flithium is used, serum 
lithium (evels should be checked daily, 
usually before the morning dosage is 
administered. (fthe level exceeds 1.5 
mEq/1. the physician should be notified 
before continuing therapy. Mood 
changes, dizziness, headache and other 
CNS complaints usually indicate 
impending toxicity. While methyldopa 
administration during lithium therapy 
predisposes the individual to lithium 
toxicity, aminophylline and 
acetazolamide decrease its effectiveness. 
lithium excretion can be promoted with 
an adequate fluid and salt intake, and 
gastrointestinal symptoms may be 
minimized by administering the 
medication at mealtimes. 



DemecJocycJine, a tetrocycJine 
antibiotic, must be administered no le
than one hour before nor sooner than 
two hours after meals. Its absorption 
may also be impaired by milk and other 
calcium containing foods. Chronic 
sufferers ofS.I.A.D.H. using long tenn 
demecJocycJine therapy should be 
advised to avoid exposure to sunlight or 
ultraviolet light to prevent severe bums. 
· Education of patient andfamily: 
Understanding the reasons for fluid 
restriction is of ultimate importance for 
patient and family compliance with 
therapy. Cooperation of some 
neurological patients is not a problem as 
awareness of thirst is very low with a 
depressed level of consciousness. 
However, with other neurological 
patients the opposite may be true, a lack 
of concentration and a poor memory 
demand frequent repetition of 
instructions. For these patients. family 
teaching is of prime importance; 
relatives and friends find it difficult to 
accept that it is not necessarily good to 
give someone a drink when it is 
requested. Both patient and relatives can 
usually be assured that this is only a 
temporary restriction. 

Neurological nurses are generally aware 
of S.I.A.D.Ho syndrome as it is a 
commonly recognized complication of 
many neurological disorders. However, 
since the causes of the inappropriate 
secretion may be so diverse. nurses in all 
fields must be aware of its possibility and 

Pituitary Stalk 

Inf. Hypophysial 

be able to recogmze the sign" and 
symptoms at their onset. thereby 
preventing the complications and 
distress ofhyponatraemia. 
As it is difficult and sometimes 
impossible to differentiate between 
lethargy and confusion caused by the 
disease entity and that caused by 
inappropriate secretion of ADH. the 
careful monitoring of electrolyte values. 
daily weights and intake and output 
records of all patients should become an 
established regime. ... 

I * American Association of 
Neurosurgical Nurses. Core curriculum. 
Maryland. 1977. 
2 AUger. R.G. Position effect on 
antidiuretic honnone blood levels in 
bedfast patients. by R.G. Augeret al. 
Arch.Neurol. 23:513-517, Dec. 1970. 
3 *Bartter, F.C The syndrome of 
inappropriate secretion of antidiuretic 
hormone, by F.C Bartter and W. B. 
Schwartz.Am.J.M. 4:!:790-ROfi. May 
4 Canddian Pharmaceutical 
Association. Compendium of 
pharmaceuticals and specialties. 1979. 
14th ed. Toronto. 1979. 
5 Cherrill. D.A. Demeclocycline 
treatment in the syndrome of 
inappropriate antidiuretic hormone 
secretion. by D.A. Chenill et al. 
Ann./ntern.Med. 83:5:654-tí56, Nov. 
6 De Troyer, A. Demeclocycline. 
Treatment for syndrome of inappropriate 

TIN Can8d"n Nur... 

antidiuretic honnone secretion.JAMA 
237:25:2723-2726, JUn. 20, 1977. 
7 -.Correction of antidiuresis by 
demeclocycJine. by A. De Trouer andJ. 
293:18:915-918, Oct. 30,1975. 
8 Dila, CJ. Cerebral water and 
electrolytes. An experimental model of 
inappropriate secretion of antidiuretic 
honnone. by CJ. Dila and H. M. 
Pappius.Arch.Neurolo 26:85-90, Jan. 
9 Fox,J.L Neurosurgical 
hyponatraemia: the role of inappropriate 
antidiuresis, by J. L Fox et al. 
J.Neurosurg. 34:506-514, Apr. 1971. 
10 Graze. K. Chronic 
demecJocycJine therapy in the syndrome 
of inappropriate A.D.H. secretion due to 
brain tumour, by 1\.. Graze et al. 
J.Neurosurg. 47:6:933-936, Dec. 1977. 
II Hantman, D. Rapid correction of 
hyponatremia in the syndrome of 
inappropriate secretion of antidiuretic 
hormone. An alternative treatment to 
hypertonic saline. by Do Hantman et al. 
Ann.lntern.Med. 78:870-875, Jun. 1973. 
12 Kuchel. O. Inappropriate 
response to upright posture: a 
precipitating factor in the pathogenesis 
of idiopathic edema, by O. Kuchel et al. 
Ann.lntern.Med. 73:245-252, Aug. 1970. 
13 \1artin, Joseph B. Clinical 
neuroendocrinology, by Joseph Martin 
et aI. Philadelphia, F.A. Davis, 1977. 
(Contemporary neurology series, v.14) 
14 Netter. F. The Ciba collection of 
medical illustrations. Vol. J. / he 
nen'ous system. Summit. N.J.. Ciba 
Phannaceutical, 1975. 
15 Rymer, 
1.M. Protective 
adaptation of the brain to water 
intoxication, by M.M. Rymer and R.A. 
Fishman. Arch.Neurol. :!/;;49-54. Jan. 
16 Vander. Arthur J. Human 
ph\'siology: the mechanisms of bod\' 
fu , nctiollS by Arthur J. Vander et al. 
Toronto, McGraw Hill, cl970. 
17 White. M.G. Treatment of the 
syndrome of inappropriate secretion of 
antidiuretic hormone with lithium 
carbonate. by M.G. White and CD. 
Fetner. New Eng.J.Med. 292:8:390-392, 
Feb. 20, 1975. 

This paper on ADH wa.
 presented by the 
two authors at the annual meeting of the 
Canadian Auociation of Neurological 
and Neurosurgical Nurses in H alifm;, 
June /979. 

Muriel Burr}, a graduate of St. 
Bartholomew's H mpital. London, 
England, is presently head nurse of 
neurology and neurosurgery at the 
Health Sciences Center, Winnipeg. 
L}dia Martens. a staff nurse in the 
neurological and neurosurgical unit at 
the Health Sciences Center, Winnipeg, is 
a graduate of the Grace General 
Hospital, Winnipeg. 



\'\\' .


. - 
 :---...'- ...,.--- 





Cris Burdis 

What type of patients benefit from 
biofeedback and behavioral therapy? 
Do psychiatric patients continue to 
practice relaxation techniques after 
discharge and do these techniques 
remain effective? Can behavioral 
treatments be carried out effectively 
by nursing staff? 

Members of the Behavior Modification 
Treatment Program of the University 
Hospital. London. Ontario. when they 
realized the answers to these and similar 

"i. "....IIIIOIJ91111.. 

questions were not readily available in 
current literature. I decided to do some 
research on their own. Through practical 
analysis, a nurse, in consultation with a 
psychiatrist and a psychologist, obtained 
some interesting results. 

Biofeedback - what is it? 
Biofeedback is the term used to describe 
a relatively new group of techniques 
whereby an individual is made aware of, 
and taught increased control of. what are 
normally considered involuntary 
physiologic responses. 
In psychiatry. biofeedback is used 
to measure and make an individual aware 
of tension levels within his body.2These 



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tension levels may be controlled by the 
autonomic or skeletal muscle system e.g. 
tachycardia frequently accompanies or 
results from high anxiety. however 
through the use of relaxation techniques 
the tachycardia may be decreased with a 
consequent reduction of anxiety.3 
To record the physiological 
measurements associated with high 
levels of arousal or tension, a polygraph 
which includes recordings of heart rate 
(electrocardiograph), muscle tension 
(electromyograph). cerebral activity 
(electroencephalograph), respiration rate 
and galvanic skin response, is used. This 
polygraph is used in both the diagnosis 
and treatment phases. 


In order for biofeedback to be used 
effectively in the treatment of any 
condition, a high activity level from one 
of the graphs must be noted. If an 
individual reporting with a migraine or 
tension headache, for which no organic 
base has been established. is found to 
have excessively high tension levels in 
his head and neck muscles, then it is 
likely that by learning to relax these 
muscles he may be able to control pain 
and headaches. However if there is no 
visible elevation of tension level. the 
benefits of biofeedback use are 
questionable and other treatment 
modules should be investigated. for 
example psychotherapy. 
High tension levels involving a 
specific organ may indicate a 
predisposition to disease. Future heart 
disease may be predicted when 
polygraph recordings of an anxious 
patient reveal heart rate increases with 
conflict or stress. 

Once it is detennined that an individual 
should respond to biofeedback use, 
treatment is initiated. The individual is 
instructed in measures to control or 
reduce tension levels by means of an 
auditory tone or visual feedback. Using 
the polygraph. tension levels ar
measured and a tone which varies with 
the changing levels of tension recorded. 
is played back. As the patient uses 
relaxation techniques, the sound lowers 
in pitch giving him continuous feedback 
about the degree of relaxation he is 
attaining. Often biofeedback is only one 
of a number ofbt:havioral techniques 
used as a result of an initial general 
behavioral assessment. 

The studv 
ls studied had psýchiatric 
diagnoses of migraine headache, tension 
headaches, anxiety neurosis and 
conversion reaction. They "ere referred 
by their family physician to the 
Behavioral Modification Treatment 
Program at University Hospital. In all 49 
persons were studied, both male and 
female, ranging in age from 21 to 78 
years; 24 with the diagnosis of anxiety 
neurosis, 14 with the diagnosis oftension 
headache. five with migraine headaches 
and six diagnosed with conversion 
In an initial interview with the 
behavioral therapist. the patient was 
given the rationale of behavioral therapy. 
Then a history of the complaint and a life 
history were documented with emphasis 
on behaviors, either learned or genetic 
which influenced the presenting 
problem. e.g. complaint of migraine 
headache with family history of similar 
complaint. Situational analysis was used 
to investigate the behavioral components 
of the pain where stimulus response 

patterns were evident, i.e. non-assertive 
behavior leading to the patient's anxiety. 
In these situations, the patient was asked 
to keep a log recording the frequency of 
his pain and the emotional and cognitive 
components which might exacerbate or 
prolong this pain. Physiological 
measures on the polygraph were also 
considered part of the assessment 
Once all of this infonnation had 
been collected. the history was 
presented to a team of behaviorally 
oriented therapists that included a 
psychologist and psychiatrist. A 
treatment module was then set up and, at 
regular intervals. the team would meet to 
discuss ongoing therapy and receive 
feedback from all disciplines, as the 
patient might be also undergoing other 
therapies such as marriage counseling or 
group psychotherapy at the time. 

Biofeedback treatment 
The actual treatment consisted of the 
application of electrodes to skin surfaces 
of the muscles near the area where pain 
wa'\ experienced: for instance, the 
us muscle is often used for 
occipital headaches and the frontalis 
muscle for frontal headaches. A sensitive 
bioelectric amplifier was used to amplify 
the minute signals generated by muscle 
cell depolarization and to present them in 
the fonn of a line graph. This seflsitive 
measurement can be gauged quite 
accurately and converted into.a tone. 
The individual. hearing this tone, was 
told that when he relaxed the involved 
muscles the pitch of the tone would 
decrease 0 To accomplish this. the patient 
learned relaxation exercises. most 
commonly the autogenic method devised 
by Wolfgang Luthe,' although 
other methods such as breathing 
techniques. hypnosis. yoga exercises. 
increasing sensory awareness and 
physical activity, such as jogging may 
also be recommended. 
Autogenic relaxation is based on a 
method known as passive concentration. 
The individual reduces tension in one 
area of his bOdy by concentrating in a 
passive and casual way on phrases 
suggesting feelings of heaviness and 
wannth in that specific part of the body. 
Passive concentration implies functional 
passivity towards the intended outcome 
of the concentrated activity rather than 
active concentration which demands 
goal-seeking and interested. alert 
attention. He says to himself, for 
example, "my forehead is cool" or "my 
ann is wann/hot" as opposed to "I want 
my ann to be wann". Once the patient 
has mastered the ability to relax in the 
laboratory situation. he is encouraged to 
use relaxation exercises at home and 
prior to facing anxiety situations in his 
life. A tape recording of the exercises 
was available for each patient to take 

The Cenadl." Hur.. 


In a relatively short number of 
sessions. averaging about eight, the 
patient was generally able to relax with 
concomitant lowering of arousal as 
measured by the polygraph. All of the 
patients in this study were treated 
behaviorally and responded reasonably 
positively to treatment. Treatment 
sessions were spread over a period of 
time ranging from one to six months. 
Following tennination of therapy. a 
follow-up questionnaire and interview 
were administered at three and six 
months. Physiological base rate 
measurements were also made of present 
tension levels. These follow-up sessions 

. a questionnaire to be filled out 
before the interview asking about life. 
mental, environmental or interest 
changes since therapy 
. patient's overview of his therapy 
. description of any physical 
symptoms still present 
. degree of relaxation still being 
. continued use of coping mechanism 
learned in therapy 
. any changes in sexual behavior 
. any mood changes. 

All the information collected was 
recorded briefly and summarized on a 
graph. Six levels of effectiveness were 
recorded ranging from level one 
indicating that the patient was very much 
worse. level three indicating the same as 
pretreatment, to level six indicating 
exceptional improvement. 

Results were examined by dividing the 
group into diagnostic categories (see 
Table one). As a group. those with the 
diagnosis of conversion reaction 
responded most favorably to 
biofeedback treatment and six months 
after therapy were doing better than 
pretreatment. Patients suffering from 
migraine headaches also seemed to be 
coping adequately and as a result were 
relatively headache-free six months 
following discharge. 
This type of treatment seemed to be 
exceptionally beneficial in the case of 
tension headaches. Unfortunately many 
of these patients did not report for the 
second follow-up interview. Those 
suffering from anxiety neurosis proved 
to be an interesting group that showed 
more variability in their graphs. 
Although generally the patients showed 
an overall improvement. this group had 
more complex problems than the others, 
of which physical tension and its 
reduction played only a small part in 
their overall personality structure. 

L I _ l 

Table one - Effectiveness le
'els foßowing biofeedback 
Diagnosis Follow-up 2 3 4 5 6 7 
Conversion Three months 5 
n.6 Six months 5 
Migraine Three months 3 
n.5 Six months 3 2 
Tension Three months 2 4 2 4 2 
n.14 Six months I 3 I 3 6 
Anxiety Three months 2 9 8 3 2 
n.24 Six months 2 2 7 5 8 
Levels 4. slight improvement 
I. very much worse 5. much better 
2. somewhat worse 6. exceptionally better 
3. same level as pretrealment 7. no show. refused follow-up 
or unable to contact 

Generally it would appear that most of 
the 49 patients in our study improved 
considerably in a variety of ways and 
continued to remain at least at a 
better-than-pretreatment level six 
months after discharge. Most of them 
continued to practice relaxation 
techniques at home at least twice weekly 
and to utilize relaxation training and 
coping mechanisms. i.e. cognitive 
therapy (an exploration into maladaptive 
thinking patterns that caused anxiety) or 
assertive skills they had learned, to deal 
with anxiety. 
The muscle tension levels measured 
at the interview were generally much 
lower than pretreatment levels, although 
often slighlly higher than at discharge. 
This would seem to support the theory 
that lowered physical tension levels 
occur with increased ability to relax and 
result in a lowering of pain. as in a 
tension headache. 
Since these results are based only on 
individuals who were deemed suitable 
for biofeedback therapy, and onl y on 
those who completed the treatment 
program, it is not possible to do more 
than delineate some broad categories 
that describe the type of individual who 
would not respond well to this type of 
treatment. These categories are: actively 
psychotic. severely depressed. 
unmotivated to therapy and at 
lower-than-average intelligence. 
Thi" study should not be considered 
a research project as it was not strictly 
controlled in many areas. since results 
were gathered from ongoing therapy. 
However, the comparatively high 
success rate of treatment, the very few 
treatment hours required. plus the fact 
that treatment was carried out by a 
registered nurse, could contribute 
considerably to the planning of treatment 
modules by hospital personnel. With 

.brUar'L1980 _ 

monetary resources at a minimum in 
most hospital budgets, and the indication 
that many patients who are difficult to 
treat with conventional psychiatry may 
respond well to biofeedback, a viable 
alternative is now available.'" 
I Tarler-Benlolo. L. The role of 
relaxation in biofeedback training: a 
 review of the literature. 
Psychol.Bull. 85:4:727-755, Jul. 1978. 
2 Dollard, John. Personality and 
psychotherapy, by John Dollard and 
Neal E. Miller, New York. 
\1cGraw-Hill. 1950. 
3 Rimm, David. BehGl'ior therapy: 
techniques alld empiricaljìlldill1{s, by 
David Rimm and John C. Masters. New 
York, Academic Press. 1974. p.6. 
4 Luthe, Wolfgang. AutoRellic 
therapy. Vol. 1 . AutoRenic method.
, by 
Wolfgang Luthe and Johannes H. 
Schultz. New York. Grune. 1969. 
I Benson. Herbert. The relaxarioll 
respOlue. New York, Morrow. 1975. 
2 Biofeedhac/... alld se(f control, 
1972-1977: an Aldille {/fill/wI 011 the 
rel?ulation ofhodil\' proce
es and 
consCÎousllen. Chicago, I L. Aldine, 
3 Ellis. Albert. A lIew l?uide to 
ratiollallil'Îllg, by Albert Ellis and 
Robert A. Harper. North Hollywood, 
CA, Wiltshire, 1975. 
4 Jonas. Gerald. Viscerallearnilll? 
New York. Pocket Books. 1974. 
5 Karlines. Marvin. Bic
turnillg Oil the power (
fyour milld, by 
Marvin Karlins and Lewis M. Andrews. 
Toronto, Lippincott, 1972. 
6 Knapp, Terry J. Behavior analysis 
for nursing of somatic di
orders. by 
Terry J. Knapp and Linda Whitney 
Peterson. Nurs.Re.L 26:4:281-287. Jul. 

Th. CanlllJ!ln Nur.e 

7 Luthe, Wolfgang. Autol?enic 
therapy, Vol. I. Autogenic methods. by 
Wolfgang Luthe and Johannes H. 
Schultz. New York. Grune, 1969. 
8 Rimm. David. Belwl'Îor therapy: 
techniques alld empirical.fìndilll?
. by 
David Rimm and John C. Masters. New 
York, Academic Press, 1974. 

Cris Burdis, a l?raduate of the Yor!.. 
School o.fGeneral Nur.
illl?, Englalld. 
lI'or!..ed in the Behal'Îor Mod!fication 
Clillic at the U lIil'ersity H o.
Londoll. Olltario and set lip a p.
liaison ll11r.
illl? .
er\'ice there. Currently, 
he is wor!..inR part-time ill the 
Outpatient Department (
f Psychiatry at 
the Uni\'ersity Hospital. sllldyinl? at the 
U nil'er.
ity (
f Western Ontario and also 
teachillR assertil'elless trailling das.
at F anshawe Community College. 




· .. · ris ., II 
cuts the cost of decubitus care 

infection fast 
Debrisan sucks bacteria and tox- 
ins out of decubitus ulcers. The 
ulcer is quickly cleansed, healthy 
granulation appears, and healing 
can begin. 
" These (wet, exudative ulcers) 
averaged two days to clear the 
superficial infection and five days 
from the onset of therapy to ap- 
pearance of good granulation 
tissue in the ulcer base." 1 





'Day 0 Infected, heavily Day 2 Exudate diminished. Day 14 Clear, healthy 
exudating decubitus ulcer on Erythema and edema granulation base; grafted 
left hip. reduced. successfully. 

...... ... 


"bÞo rl 

by relieving 
pain and 
ooour fast 

f '.... 

Day 0 Infected exudating Day 4 Clear, healthy 
decubitus ulcer on knee. granulation base. 

Day 14 Ulcer healing after 
Debrisan discontinued. 

.. All patients in whom rest pain was 
present at the start of treatment 
noticed almost immediate relief of 
the rest pain when Debrisan was 
applied to the wound."2 
.. Debrisan was commenced and the 
following day, tþe smell had disap- 


Day 0 Undermined sacral Day 7 Surgically debrided Day 28 Appearance on 
decubitus ulcer infected with before Debrisan therapy and healing. 
Pseudomonas and E.coll. after 7 days, infection 

by saving valuable nursing time 
Only one Debrisan change a day. ø 
is needed. Debrisan therapy can " 
be stopped as soon as all signs of 
infection have gone and the ulcer 
is clean and granulated. 
.. Debrisan appears to be, in my 
opinion, just what we as nurses 
are seeking."



'T_, I' e"udIotion I. "'Y "'wy. 

After removing crust or 
necrotic tissue, pour a thick 
(4 mm) layer of Debrisan on 
the ulcer. 

Cover with a dressing. 

When the beads are 
saturated (12 to 24 hours 
later) rinse and wipe them 
away. Apply a fresh layer of 

, Debrisan 8 cleans 
decubitus ulcers fast. 

.. Phannacia (Canada) Ltd. 
'-' Dorval, Québec 

1. Llm LT, Mic:huda M,.....n JJ, Angiology 29:9, Sept 1978 
2. Bewick M, Andereon A, Clln TrIal. J 15:4, 1978 
3. Soul J, Srll J Clin PIKt, 32:1, June 1978 
4. DlMacfo S RN, Decubdus c.. A N_ ApproM:ft: 
A Nweing ReeponeIbIHty, on file al PhIInMCle CCanecIIo) LId. · Reg. T.M. 

(You and the Løw continued from page 11) 
Concern has been expressed that 
such an extension of hospital legal 
liability will result in undue interference 
in medical practice and, in particular, in 
the implementation of medical 
innovations and novel procedures. In 
respect of the latter, it is feared that 
hospitals, mindful oflegal risks, will 
prevent the use of such techniques, 
thereby severely hampering the 
development of medicine and the 
potential benefits to patients. On the 
othf'r hand, the decision has been viewed 
as a positive step in protecting the public 

interest and expectation in ensuring that 
the public does not receive substandard 
health care. 
The direction the law takes from 
here will depend on the outcome of the 
review of this landmark decision by our 
appellate courts. '" 

"You and the law" is a regular column that 
appears each month in The Canadian Nurse 
and L'ir!/irmière canadienne. Author Corinne 
L. Sklar is a recent graduate of the Uni
ofT oronto Faculty of Law. Prior to entering 
law school, she obtained her BScN and MS 
degrees in nursing from the Uni
'ersity of 
Toronto and University of Michigan. 

1 Yepremian v. Scarborough 
General Hospital (1978), 200.R. (2d). 
2 Hillyer v. St. Bartholomew's 
Hospital, [1909] 2 K.B. 820 (C.A.). 
3 Fleming,J.S.The law of torts. 4th 
ed. Sydney, Law BookCo., 1971. p.318; 
and see also Darling v. Charleston 
Community Memorial Hospital (1965) 
211 N.E. 2d. p.253. 
4 Cassidy v. Mi nistry of Health, 
[1951] 2 K.B. 343 (C.A.). 
5 [1972] S.C.R. 435. 
6 Yepremian, op.cit. p.517. 
7 Ibid., p.518. 
8 Ibid., p.521. 
9 Ibid., p.521-522. 
to Ibid. p.522. 
II Ibid., p.533-534. 
12 Ibid., p.522. 
13 The hospital established the 
importance of personal staffselectlon 
before the same trial judge inRe: Board 
of Governors of Scarborough General 
Hospital and Schiller (1974) 4 O.R. (2d) 
14 The Public Hospitals Act, R. S.O. 
1970, c.378 s.41. 
15 Yepremian, op.cit., p.534. 
16 Ibid. 

Ovol Drops 
infant colic. 





Ovol []Cffi 
a Ifas! 
_ actlni 
' 0 relief 
o Jf Infant 

Ovol Drops contain simethicone, 
an effective, gentle anti flatulent 
that goes to work fast to relieve 
the pain, bloating and discomfort 
of infant colic. Gentle pepper- 
mint flavoured Ovol Drops. 
So mother and baby can get 
a little rest. 


Shhh. Ovol Drops. 

Also8v81lablt:' In tablet form for adults 

*Unable to verify in CNA Library 



Antiflatulent Simethicone 

OVOL is indicated to relieve bloating, 
flatulence and other symptoms 
caused by gas retention including 
aerophagia and infant colic. 
None reported. 
Protect OVOL DROPS from freezing. 
None reported. 
Simethicone 80 mg 
Simethicone 40 mg 
Adults: One chewable tablet between 
meals as required. 
Simethicone (in a peppermint 
flavoured base) 40 mg/ml 
Infants: One-quarter to one.half ml as 
reqUired. May be added to formula or 
given directly from dropper. 

if HORnER 
v Montrèal Canada 

.- _ 


."r.....-or>o"'_ r.......

VE FUN')f 

. ),. 
It's the CNA in B.C. - a pot pourri for you to see 

The RNABC is looking forward to June 
and the CNA biennial meeting here in 
Vancouvero Vancouver is one of the most 
beautiful cities in North America: it boasts 
a natural harbor, a rugged mountain 
backdrop, lush forests and sandy 
beaches. Culturally, the city has an 
abundance of art galleries, museums, 
theatres and clubs. Restaurants are 
many and varied, specializing in seafood 
and ethnic cuisine such as WestCoast 
Indian, Hungarian, Indonesian, French, 
Greek, Italian...the list is endless. 
The RNABC is planning to offer 
delegates a number of local tours during 
the off-hours of the June convention. 
Specific details and registration for these 
tours will be available once you arrive. In 
the meantime, however, here are just a 
few of Vancouver's interesting 

1 '. 
,'JI -- 



VancouI'er waJeifront 

Stanley Park 
Located within walking distance of 
downtown, Stanley Park is 404 hectares 
of natural woodland, nature trails, 
gardens, picnic sites and playing fields. 
There's a zoo with monkeys, polar bears 
and otters. Tennis courts, a miniature golf 
course, a giant checkerboard and lawn 
bowling provide lots of recreational 
The largest and most exciting 
aquarium in Canada is also located in 
Stanley Park. Most popular is the Marine 
Mammal Complex where up to 700 
spectators can enjoy performances by 
playful dolphins and killer whales. The 
McMillan Tropical Gallery houses a 
variety of ocean and freshwater fish. 
Stanley Park has been described as 
one of the greatest parks in the world and 
it certainly lives up to that description. 

Museum of Anthropology 
Situated on the Point Grey cliffs 
overlooking Howe Sound and the North 
Shore Mountains, the Museum of 
Anthropology contains a famous 
collection of Indian artifacts. It is unusual 
in having most of its collections on 
permanent view, either in exhibition 
galleries or in special storage areas 
accessible to the public. The collection 
features a unique group of totem poles 
displayed in the splendid Great Hall. 
While the best known artifacts represent 
coastal Indian art. there are other 
collections from elsewhere in North 
America, the Pacific Islands, Asia and 

Vancouver's Chinatown is the second 
largest in North America, exceeded only 
by that of San Francisco. Its commercial 
center is concentrated in a three block 
Oriental "bazaar" where the treasures of 
the East are displayed: ivory, jade, 
colorful brocades and exotic foods. One 
corner boasts a structure designated by 
"Ripley's Believe it or Not" as the 
"World's Thinnest Office Building". Some 
of Vancouver's most popular restaurants 
are located in Chinatown. 

11 I , 
, II 

. .1 

I - 

 t :' 

I , 





Gastown is a must for the Vancouver 
visitor. It is a prime example of urban 
renewal. Because the area is designated 
as an historic site, shops are allowed to 
remain open on Sundays. With its mews 
and intriguing cul-de-sacs, Gastown is an 
interesting blend of past and present. 
Boutiques, specialty shops, antique 
stores, art galleries and colorful street 
vendors provide a wide range of choice 
to the shopper. 

Shopping Malls 
Several underground shopping malls are 
within blocks of each other. Pacific 
Centre Mall, the largest, connects 
through its lower floor with the Bay, 
Eaton's, Four Season's Hotel and the 
Vancouver Centre Mall which is below 
Birks. The two malls are below Granville 
Mall, where most of the downtown movie 
theatres are located. The Royal Centre 
Mall, two floors of shops and restaurants, 
is below the Hyatt-Regency Hotel where 
the convention is being held. Harbour 
Centre Mall is below Simpsons-Sears on 
the waterfront and connects with 


 .' f
. \ \ 
\ I 



I ' ' 

- , 



" 1'1 

\'... j 
.,, I, 


., ---. 

Downtown VancouI'er 


Grouse Mountain Skyride 
This aerial tramway takes you to an 
elevation of 1100 m (3700 feet) and 
provides spectacular view of the city, day 
or night. The mountain is only 15 minutes 
from downtown; also at the peak are 
nature walks, special gift shops, chairlift 
rides, a restaurant and lounge and a 

Post-conference tours 
Here are some brief descriptions 
and costs for the post-convention trips. 
More information is available directly 
from Kanata Conference Consultants. 
Kanata Conference Consultants Inc. 
307 - 837 W. Hastings Street 
Vancouver, B. C. V6C 1 B6 
Note also that Kanata will make your 
plane reservations for you. You should 
plan on booking your flight from your 
hometown with a stop-over in Vancouver 
for the CNA conference. This will save on 
air fare. 

Books for a new 
decade of nursing . 

Tilkian & Conover 
Here's an exciting package that provides a basic famil- 
iarity with normal heart sounds and allows recognition of 
life-threatening disorders manifested by abnormal heart 
sounds. Package includes C-60 cassette plus soft cover 
By Ara G. Tilkian. MD, FACC. Asst. Clinical Prof of Medlcme (CardIol- 
ogy), Univ. of California School of Medicine, Los Angeles; and Mary 
Boudreau Conover. RN, BSN. Ed, Instructor of Critical Care Nursing 
and Advanced Arrhythmia Workshops, West Hills Hospital and West 
Park Hospital. Canoga Park, CA. Book only: 122 pp IIlustd Soft 
cover. $10.75. April 1979 Order flS869-1. Package: $20.35. 
Order flSS7S-0. 

A unique new learning concept for nurses! This one-of-a- 
kind manual provides an excellent foundation for study- 
ing the nursing process in maintaining basic functions, 
from respiratory and nutritional. . . to psycho-social and 
electrolyte status. Six major units are divided into 
modules, each with its own glossary, objectives. 
self-tests, post-tests. and answers. Excellent for use in 
a traditional learning environment, or for an independent, 
self-paced program. Instructor's guide available now. 
By Eloise R. Lee, RN, MEd, Asst Prof., Cedar Crest College, School 
of Nursing, Allentown, PA About 450 pp. Soft cover About $13.80 
Ready soon. Order fl5697-S. 

Corbett & Beveridge 
Here's an approach that allows readers to apply problem- 
sOlving skills to medical-surgical nursing-and it's been 
class-tested as well! Corbett & Beveridge offers an 
exhaustive treatment of six decision trees in a unique 
learning format. Readers are guided through these 
clinical situations using a series of self-testing questions 
to examine decision-making skills. As readers progress, 
they encounter rationales for both correct and incorrect 
action. The volume functions as an adjunct to COurses on 
any level, as well as for self-teaching and review. 
By Nancy Ann Corbett, RN, EdM. Assoc. Prof.. College of Allied 
Health Sciences, Thomas Jefferson Univ., Phila.. PA: and Phyllis 
Beveridge. RN. EdM, Lecturer. College of Health SCiences. Unlv 
of Bridgeport, CT 332 pp. Soft cover. $11.95. January 1980 Order 

Wood & Rambo 
Volume 3 
2nd Edition 
Getting down to basics is what this new second edition is 
all about! It features a complete reorganization of con- 
tents leading from general hospital setting, to simple 
skills, to mOre complex ones. This volume covers more 
advanced skills, breaking each skill into step-by-step 
segments supported by scientific information and 
practical hints. Post-tests, performance tests and per- 
formance check-lists for each unit are included. 
Edited by Lucile A. Wood, RN. MS, Dlfector of Nursing, Bay Area 
Hospital. Coos Bay, OR; and BeverlyJ. Rambo, RN, MA. MN. Asst 
Prof of Nursing, Mt St. Mary's College, Los Angeles, CA About 
525 pp Illustd Soft cover. About $13.80. Ready soon Order fl9607-4. 

Keane & Fletcher 
4th Edition 
This unique programed text presents material in short 
steps with immediate feedback and reinforcement. You II 
find ratio and proportion for solving al/ problems with 
no formulas to memorize. Additionally, you'll find all 
mathematics necessary for you to know in medication 
By Claire B. Keane, RN, BS, MEd; and Sybil M. Fletcher, RN. BS. 
About 170 pp lIIustd. Soft cover About $900. Ready soon 
Order fl5343-X. 

LeMaitre & Finnegan 
4th Edition 
This excellent revision provides an outline of operative 
procedures for the student, graduate nurse, and O.R. 
technician. The fourth edition includes many new chap- 
ters including one on surgical stress, and expanded 
information on post-operative assessment for many of 
the procedures. Order now! 
By George D. LeMaitre, MD, FACS, Diplomate AM BD of Surgery, 
Surgeon-in-Chief, Lawrence General Hospital; Senior Surgeon, 
Bon Secours Hospital; and Janet A. Finnegan, RN. MS, Assoc. Prof., 
Northeastern Univ. College of Nursing, Boston, MA About 545 pp., 
120 ill About $16.20 Ready soon. Order fl5724-9. 

Drain & Shipley 
Two leading experts provide clear, accurate coverage of 
the recovery room in this exciting book. Topics Include 
the physiology of anesthesia, the effects of various 
anesthetic agents, specific care after all types of opera- 
tions, and factors that affect recovery from anesthesia 
in particular patients. 
By Cecil B. Drain, RN, CRNA, BSN, Major, Army Nurse Corps, Univ 
of Arizona, Tucson: and Susan B. ShIpley, RN, MSN, Major, Army 
Nurse Corps; Nurse Researcher, Waller Reed Army Medical Center, 
Washington. DC 608 pp 167 ill $20.35. March 1979 Order fl31S6-X 



WB. Saunders Company 

1 Goldthorne Avenue, Toronto. Ontario MSZ 5T9. Canada 

Send on no-risk 3D-day approval 
o Corbell #2722-6 
o Keane #5343-X 
o Lee #5697-8 
o LeMailre #5724-9 

o Drain #31 86-X 
o Wood #9607-X 
o Tilkian #8878-0 

o cheek enclosed - Saunders pays postage 

Please Pnm 







CN 2/80 

The Best of Walklkl and Maul 
This exciting 14-day package costs $905 
per person. You will stay seven nights in 
Waikiki and seven nights in Maui. 
Your hotel in Waikiki is right across 
from the famous Waikiki Beach. All 
rooms are air-conditioned with private 
baths and color television. The hotel has 
a large freshwater pool with a spacious 
sun deck. You will enjoy elegant dining 
and live entertainment nightly. 
In Maui, your hotel room will have a 
porch overlooking the grounds or the 
ocean. Each room has a private bath, 
air-conditioning and color television. This 
hotel is a haven for the golf or tennis 
enthusiast. It has 11 tennis courts and is 
within easy walking distance of a golf 
course. Eight freshwater pools with 
adjacent snack bars will add to your 
vacation comfort. 

San Francisco Cable Car Caper 
This package includes three nights/four 
days, with a price per person of $290. 
You depart from Vancouver on a 
Thursday and return in time to connect 
with flights to Eastern Canada. 
Once in San Francisco, you are 
taken right to the city's center, 
Fisherman's Wharf and given a choice of 
several tours, such as a bay cruise or a 
tour of the city. Your trip to the "city by the 
Bay" can be extended to seven 
nights/eight days for a price of $439 per 
person. That gives you four additional 
days and nights to shop, explore or just 

Seven nights of excitement, 
entertainment and fun await you in Reno. 
You depart from Vancouver on a Sunday 
and return the following Sunday in time to 
connect with eastern flights. For $299, 
you are offered a modern room in one of 
the largest hotels in downtown Reno. The 
hotel includes a fine casino, restaurant, 

i I 

For those who would like to develop 
further their professionaJ potential and to 
earn University credits while working 
Canadian School of 
in affiliation with 
Northland Open University 
offer two programs: 
Bachelor of Professional 
Studies or 
Bachelor of Management 
Nurses, technicians. technologists and 
all holders of Community College 
diplomas may apply to the Upper Level 
of the Program. Credits are given for 
prior learning and experience. 
Saturday tutorials or study at a distance 
(for those who reside outside of Toronto) 
For more information please write to: 
bool of Management 
S-425, 252 Bloor St. W. 
Toronto, Ontario 

pool and lots of bars A casino package 
valued at over $100 and a hearty snack 
and open bar/champagne flight, are just 
a few of the added items included in this 

Scenic Victoria 
Several options are offered if you are 
interested in visiting the distinctive city of 
Victoria on Vancouver Island. A one-day 
excursion to the city costs $38.50 and 
includes your ferry trip, the Butchart 
Gardens, the city center, parliament 
buildings, provincial museum, Uplands 
and Oak Bay. If you want to spend two 
days in Victoria, you can see all of the 
above plus more. A guided walking tour 
of the city center is also provided. Total 
cost of the two-day trip is $125 per 

Royal Hudson Steam Train Trip 
This 1 O-hour excursion costs $29.50 per 
person. You will be picked up at your 
hotel at 8:45 a.m. and transferred to the 
Royal Hudson. This old steam train 
travels along Howe Sound to Squamish, 
where you will enjoy a leisurely lunch. On 
the return trip, there are stops at 
Britannia Beach Mining Museum. 
Shannon Falls and Alice Lake. 

Alaska Cruise 
This eight-day cruise aboard the Island 
Princess departs Vancouver on June 27 
at 8:00 p.m. There are six ports of call 
during the cruise. Shore excursions at 
these ports are sold aboard ship. 
Two types of accommodation are 
offered - type "F' staterooms include 
outside two bedded rooms with private 
facilities on Aloha deck, for a cost of US 
$1608 per person. type "G" 
accommodation includes outside two 
bedded room with private facilities on the 
Fiesta deck, for a cost of US $1512 per 
person. Fare includes transportation, 
meals and entertainment. 


, ìJ ." 

I 1 j It 

. I' ....... 

"ancouver skyline and mountains In the distance 

Vi FUN IItf 



'<ii. ..1111'" ... 

_. ' 

. ".... 

.:.; -.... :.: 

QoQ .... 

 QO b(hl 

-I \)tJ\':I 



Comfortably prevents patients from slid- 
ing in wheelchairs or geriatric chairs Soft 
polyurethane cu
hion is so soft your pa- 
tient will hardly know it'
 there Wash- 
able Sm, med. Ig. 
No_ 4125 

,\f - 




 prevent footdrop or rotatIon while 
allowing loot movement. Rigid pla
shell with soft liner support
 the foot and 
keeps the weight of bedding off of the 
foot 'T' Bar stabilizes foot 
No. 6412 





Get the added plus of 
houlder loops and 
straps_ Comfortable vest Criss-crosses In 
front or rear and wai
t belt ties to bed 
spring frame Excellent In wheelchairs too. 
Sm.. med_.lg_ 
No. 3111 

Dimensions Ltd. 
2222 S. Sheridan Way 
Mississauga, Ontario 
Canada L5J 2M4 
Phone: 416/823-9290 


Serving the Health Professions in Canada Since 1897 

liBRARY '- -- 

PRACTICE, 2nd Edition 
By Lillian Sholtis Brunner, R.N., B.S. 
M.S.No; and Doris Smith Suddarth, 
R.N., B.S.N.E., M.S.N. With nine 
This monumental Second Edition of a 
modem classic-the most comprehen- 
sive single-volume reference on nursing 
practice ever published-incorporates 
massive revision and updating to offer 
the latest and most accurate informa- 
tion available. 
Hundreds of illustrations depict the 
highlights of treatment and nursing 
management (over 100 illustrations 
are new!). 
Lippincott. 1,868 Pages. 
Illustrated. 1978. $32.25. 
By Harriet Lucille Schneider, R.N., 
B.S.N.E., M.A., M.Ed., Ed.D., 
This intriguing text explores aU facets 
of an old and perplexing problem -the 
evaluation of clinical nursing compe- 
tenceo Thoroughly researched sections 
present the major evaluation theories 
and analyze the effectÏ\'eness of such 
specific situational methods as mock 
laboratories, programmed patients, 
videotapes, and computer-assisted 
simulations. Specific fOnTIs, check- 
lists, and sets of questions are provided 
for evaluative purposes. 
Little, Brown. 175 Pages_ 
Illustrated. March, 1979. Abt. $8.50. 


Edited bv Stewart M. Brooks, M.S. 
A comprehensive reference on aU 
drugs commonly encountered in nurs- 
ing practice. Section I CLASSIFI- 
CATION OF DRUGS reviews all of 
the standard drug classes relative to 
action and use, listing (and cross-ref- 
erencing) its members. Section II, 
USED DRUGS, presents in alpha- 
betical order more than 500 mono- 
graphs covering all drugs which the 
nurse will encounter in normal prac- 

Little, Brown. 500 Pages. 19780 
Paper, $14.50. Cloth, $27000. 



By Charlotte Kopelkc Eliopoulos, 
R.N., M.S. 
comprehensive treatment of the sub- 
ject with a balanced coverage of psy- 
chosocial factors, pathophysiology and 
nursing considerations. Specific cover- 
age is given to measures designed to 
promote good respiration, elimination 
and activity anù to compensate for 
age-related changes interfering with 
these functions. Illness conditions of 
each body s} stem .J.ud their unique 
features in the aged are discussed in 
Harper & Row. 384 Pages. 
Illustrated. 1979. $15.00. 

By Voncile M. Smith, Ph.D.; and 
Thelma A. Bass, M.A. 
This timely book identifies and des- 
cribes problem situations stemming 
from communication breakdowns that 
commonly affect health care 
Lippincott. 236 Pages. March, 1979. 


By Robert Kolodny, MoD.; et. al. 
This comprehensive work on human 
sexuality provides the nurse with a 
knowledge of human s
xuality that 
will enable her to care for her patient 
in the emotional and social, as well as 
the physical realms. 
Little, Brown. 431 Pages. Illustrated. 
1979. Paper, $15.00. Cloth, $21.00. 

A Comprehensive 
Nursing Approach 
By Patricia McCall Comoss, RoN., 
C.C.R.N., et. alo 
Although comprehensive in its nursing 
practice descriptions, this book is not 
a primer on basic cardiac care. The 
how's and why's of this modem trans- 
fonnation span all the chapters in 
Lippincott. 334 Pages. 
Illustrated. 1979_ $20.25. 

I J. B. LIPPINCOTT COMPANY OF CANADA LTD. Bo?ks are shipped On Approval;.if you are not entirely. I 
I 7!) Horner Ave., Toronto, Ontario M8Z 4X7 satisfied you may return them wlthm I!) days for full credIt. I 
I Please send me the following 'on approval': Name I 
I 1 2 3-P 3-Cl 4 5 6 7 Address I 
I City Provo I 
I Prices subject to change without notice. I 
Postal Code 
I 0 Payment enclosed (postage and handling paid) Prices subject to change without notice. I 
I 0 Bill me (plus postage and handling) CN2/80 I 




RqIItered N..... required for full time work on 
Medicine and Pediatrics as well as Sul'llery and 
Maternity. To work rotatina shifts. Positions availa- 
ble immediately. Apply to: Director of Nursina, St. 
Joseph's General HospitaJ, P.O. Box 490, Vq- 
reville, Alberta TOB 4LO. Phone: 1-403-632-2811. 

Rqlstered Nunes required for a S60-bed acute care 
hospitaJ in Edmonton, Alberta. Positions available in 
most clinical areas. Candidates must be eligible for 
registration in Alberta. Current salary rates under 
review. Apply to: Personnel Department, Edmonton 
General Hospital, 11111 Jasper Avenue. Edmonton. 
Alberta TSK OL4 

British Columbia 

ExperleDCeCI Genenl Duty Graduate Nunes required 
for smaIl hospital located N .E. Vancouver Island. 
Maternity experience preferred. Personr.el policies 
accordina to RNABC contract. Residence accom- 
modation available S30 monthly. Apply in writina to: 
Director of Nursina, St. George's Hospital, Box 223, 
Alert Bay, British Columbia, VON IAO. 

The "boom" of our northern city continues! We still 
require MglnnlDg or experienced practltlonen for our 
nursing departments. If experienced, we will give 
you opportunity to try some of your i4eas. If 
beginning. we will give you opportunity to expand 
your sk
ls and knowledge. Contact: Mrs. A. 
Henriksen. Nursing Director, Dawson Creek and 
District Hospital. 11100 13th Street, Dawson Creek. 
British Columbia V IG 3W8. 

General Duty Nurse for modern 3S-bed hospital 
located in southern B.C. 's Boundary Area with 
excellent recreation facilities. Salary and personnel 
policies in accordance with RNABC Comfortable 
Nurse's home. Apply: Director of Nursing, Bound- 
ary Hospital, Grand Forks, British Columbia, VOH 

Experienced Nunes (B.C. RegIstered) required for a 
newly expanded 463-bed acute, teaching, regional 
referral hospital located in the Fraser Valley, 20 
minutes by freeway from Vancouver. and wìthin 
easy access of various recreational facilities. Excel- 
lent orientation and continuing education program- 
mes. Salary-I979 rates-SI30S.00-SIS42.oo per 
month. Clinical areas include: Operating Room, Re- 
covery Room, Intensive Care. Coronary Care, 
Neonatal Intensive Care, Hemodialysis, Acute 
Medicine, Surgery, Pediatrics. Rehabilitation and 
Emergency. Apply to: Employment Manager, Royal 
Columbian Hospital, 330 E. Columbia St., New 
Westminster, British Columbia, V3L 3W7. 

Experienced Nunes (eligible for B.C. Registration) 
required for full-time positions in our modem 
300-bed Extended Care Hospital located just thirty 
minutes from downtown Vancouver. Salary and 
benefits according to RNABC contract. Applicants 
may telephone S2S-0911 to arranae for an interview. 
or write giving full particulars to: Personnel Direc- 
tor, Queen's Park Hospital, 31S McBride Blvd., 
New Westminster, British Columbia, V3L SE8. 

Reaistered Nunes required for both acute and 
extended care in a l2S-bed hospital in the South 
Okanagan. Experience in obstetrics and medical- 
surgical preferred. RNABC contract in effect. Apply 
stating qualifications and experience to: Nursina 
Administrator, South Okanagan General Hospital. 
Box 76{J, Oliver, British Columbia, VOH ITO. Phone: 

British Columbia 

Genera( Duty RN'. or Graduate Nunes for S4-bed 
Extended Care Unit located six miles from Dawson 
Creek. Residence accommodation available. Salary 
and personnel policies accordina to RNABC. Apply: 
Director of Nursina, Pouce Coupe Community 
HospitaJ, Box 98, Pouce Coupe. British Columbia or 
call collect (604) 786-S791. 

ExperleDCeCI General Duty Nunes required for 
1300bed hospitaJ. Basic Salary SI,30S.00-SI.S42.oo 
per month. Policies in accordance with RNABC 
Contract. Residence accommodation available. 
Apply in writing to: Director of Nursing, Powell 
River General HospitaJ, .5871 Arbutus Avenue. 
Powell River, British Columbia V8A 4S3. 

Keglstered Nunes required immediately for a 340- 
bed accredited hospital in the Central Interior of 
B.C Registered Nurses interested in nursing posi- 
tions at the Prince Geol'lle Regional Hospital are 
invited to make inquiries to: Director of Personnel 
Services. Prince George Regional Hospital. 2000- 
ISth Avenue, Prince Geol'lle, British Columbia, 
V2M 1S2. 

Rqlstered Nunes required for pennanent fulltime 
position at a l47-bed fully accredited regional acute 
care hospital in B.C. Salary at 1979 RNABC rate 
plus northern living allowance. One year experience 
preferred. Apply: Director of Nursing, Prince 
Rupert Regional HospitaJ, 130S Summit Avenue. 
Prince Rupert, British Columbia, VSJ 2A6. Tele- 
phone (collect) (604) 624-2171 Local 227. 

General Duty Nunes requIred by an active 8O-bed 
acute care and 40-bed extended care hospital located 
in the Cariboo region of B.C's central interior. 
Year-round recreational activities in this fast grow- 
ing community. Applicants eligible for B.C. registra- 
tion preferred. Apply in writing to: The Director of 
Nursing. G.R. Baker Memorial Hospital, .543 Front 
Street, Quesnel. British Columbia V2J 2K7. 

RealRered Nurwe required immediately for penna- 
nent full time positions at to-bed hospitaJ in B.C. 
Salary at 1978 RNABC rate plus northern living 
allowance. Recognition of advanced or primary care 
education. One year experience preferred. Apply: 
Director of Nursing, Stewart General Hospital, Box 
8. Stewart, British Columbia, VOT IWO. Telephone: 
(604) 636-2221 Collect. 

General Duty Nunes required for an active, IOJ-bed 
hospital. Positions available for experienced R.N's 
and recent Graduates in a variety of areas. RNABC 
Contract in effect Accommodation available. Apply 
to: Director of Nursing. Mills Memorial Hospital, 
4720 Haugland Avenue. Terrace. British Columbia 
V8G 2W7. 

Experienced maternKy, I.C.U.(C.C.U., and Operat- 
IDI Room Genera( Duty nu.-.s required for 103-bed 
accredited hospitaJ in Northern B.C. Must be 
eligible for B.C. registration. Apply in writing to the: 
Director of Nurses, Mills Memorial Hospital, 4720 
Haugland Avenue, Terrace, British Columbia, V8G 

Rqlstered Nunes - Full-time and casual relief 
positions are available at the University of British 
Columbia, Health Sciences Centre, Extended Care 
Unit. The 12 hour shift, the problem oriented record 
charting system, and emphasis on maintaining a 
nonnal and reality based clinical environment, and 
an interprofessional approach to management are 
some of the features offered by the Extended Care 
Unit. Interested applicants may enquire by calling 
228-6764 or 228-2648. Positions are open to both 
male and female applicants. 

British Columbia 

Unlvenhy of Victoria, School of NunlDl' Applica- 
tions are invited for positions on the faculty of the 
School of Nursing, University of Victoria. The 
School offers a two-year post-R.N. programme 
leadina to a B.Sc.N. and plans to develop both a 
basic and a master's programme. Qualifications: 
Master's degree required. doctorate preferred. Ex- 
perience in university teaching an asset. Apply to: 
Director, School of Nursing, University of Victoria, 
P.O. Box 1700, Victoria, British Columbia V8W 

Northwest Territories 

The Stanton Yellowknife HospitaJ, a 72-bed accre- 
dited, acute care hospitaJ requires registered nurses to 
work in medical, sUl'llical, pediatric, obstetrical or 
operating room areas. Excellent orientation and 
inservice education. Some furnished accommoda- 
tion available. Apply: Assistant Administrator. 
Nursing, Stanton Yellowknife HospitaJ, Box 10, 
Yellowknife, N.W.T.,XIA 2N!. 


OperatInK RCMlm Nurse-A poSitIOn exists in the 
Operating Room for a Regular full-time Registered 
Nurse. Minimum of two years' recent experience in 
an Operating Room. Preference will be given to 
applicants with recent post graduate education. 
Interested applicants should submit their resume to: 
Ms. D. Roscoe, Director of Nursing. Weiland 
County General Hospital. Third Street, Weiland, 
Ontario 1.3B 4W6. 


Rellstered None for summer camp in the Lauren- 
tians, mid-June to end of August. Congenial sur- 
roundings. Resident doctor. Contact: Myron Good- 
man. Executive Director, YM-YWHA Wooden 
Acres Camp, SSOO Westbury Avenue, Montreal, 
Quebec H3W 2W8. Telephone: (S141 737-MSI, 

Camp Nunes required for children's summer camp 
in beautiful Quebec Laurentians. Mid-June to end of 
August. Resident M.D. Contact: Mr. Herb Finkel- 
bel'll, Director of Camp B'Nai B'Rith, SISI Cote St. 
Catherine Rd., Suite 203, Montreal, Quebec H3W 
I M6. or telephone (SI4) 73.5-3669. 


Four RoN.'s urgently needed for 8 bed modem 
hospital in southern Sask. Must be eligible for 
S.R.N.A. registration. Please apply to: Administra- 
tion, Beechy Union Hospital, Box 68, Beechy, 
Saskatchewan SOL OCO or Telephone 13061 8.59- 

Director of NurslDl required for IO-bed hospital 
located in Pangman, Saskatchewan. pangman is 
situated 6S miles south of Regina and 3S miles west 
of Weyburn. Housing facilities available at present. 
For more infonnation please contact and apply to: 
Kathy Beach, Administrator, Pangman Union Hos- 
pital. Pangmano Saskatchewan SOC 2CO. 

Applications are invited for the position of Reals' 
tered General Duty Nurse in a small 18-bed hospital 
located in the beautiful rural northwestern Sas- 
katchewan. Salaries. fringe benefits. etc., as per 
S.U.N. Agreement. Apply to: Margarete Lathan, 
Director of Nursing, Box 179, Paradise Hill, 
Saskatchewan SOM 2G0 or phone: (306) 344-22SS. 


University of Saskatchewan, College of Nursing. 
FlICulty poø1tIoDl will be available in the College of 
Nursing July I, 1980. Applicants with doctoral or 
master's degree will be considered for tenurable 
appointment. Limited-tenn appointments will also 
be available to replace faculty on leave of absence. 
The undergraduate baccalaureate program is integ- 
rated and conceptually based . Team teaching is the 
mode used in most classes and all faculty are 
expected to have specialization in a clinical area and 
to participate in clinical supervision of students. 
Level of appointment and salary will be commensu- 
rate with previous experience in teaching, research, 
and clinical nursing. Further information may be 
received from: Hester J. Kernen, Professor and 
Dean, College of Nursing, University of Saskatche- 
wan, Saskatoon, Saskatchewan sm OWO. 

United States 

CaUfornla - Sometimes you have to go a long way 
to find home. But, The White Memorial Medical 
Center in Los Angeles, California, makes it all 
worthwhile. The White is a 377-bed acute care 
teaching medical center with an open invitation to 
dedicated RN's. We'll challenge your mind and offer 
you the opportunity to develop and continue your 
professional growth. We will pay your one-way 
transportation, offer free meals for one month and all 
lodging for three months in our nurses residence and 
provide your work visa. Call collect or write: Ken 
Hoover, Assistant Personnel Director, 1720 Brook- 
lyn Avenue, Los Angeles, California 90033 (213) 
268-5000. ext. 1680. 

Total patient care with all licensed personnel is our 
goal! Staff RNs currently interviewing for part-time 
and full-time positions. Full service, except psych, 
progressive 156-bed accredited acute general hospi- 
tal. Located within 60 minutes from LA, the ocean, 
mtns., and the desert. Orientation and staff de- 
velopment programs. CEUs provider number. 
Park view Community Hospital, 3865 Jackson Street, 
Riverside, California 92503. Write or call collect 
714-688-2211 ext. 217. Betty Van Aernam, Director 
of Nursing. 

RN'S - Our Florida hospitals need you! Join the 
manr Canadian RN's who are currently eqjoying 
Flonda's Gulf Coast beaches, sun, and exciting 
recreational activities. We will provide work visas, 
help you locate a position, find housing, and arrange 
your relocation. No Fees! CalI or write: Medical 
Recruiters of America, 1211 N. Westshore Blvd., 
Suite 205, Tampa, Florida 33607 -(813) 872-0202. 

JI1DrIda Nunlq OpportllJlltlee - MRA is recruiting 
Reaistered Nurses and recent Graduates for hospital 
positions in cities such as Tampa, St. Petersburg, 
and Sarasota on the West Coast; Miami, Ft. 
Lauderdale and West Palm Beach on the East Coast. 
If you are considerina a move to sunny Florida, 
contact our N une Recruiter for assistance in 
selecting the riaht hospital and city for you. We will 
provide complete Work Visa and State Licensure 
infonnation and offer relocation hints. There is no 
placement fee to you. Write or call Meclkal 
rlca,IIIC.(ForWestCoast) 1211 N. 
Westshore Blvd., Suite 205, Tampa, Fl. 33607 (813) 
872-0202; (For East Coast) 800 N.W. 62nd St., Suite 
510. Ft. Lauderdale, Fl. 33309 (305) 772-3680. 

Nunes - RNs - Immediate Openings in 
California-Florida-Texas-Mississippi - if you are 
experienced or a recent Graduate Nurse we can offer 
you positions with excellent salaries of up to $ 1300 
per month plus all benefits. Not only are there no 
fees to you whatsoever for placing you, but we also 
provide complete Visa and Licensure assistance at 
also no cost to , ou. Write immediately for our 
application even i there are other areas of the U. S. 
that you are interested in. We will call you upon 
receipt of your application in order to arrange for 
hospital interviews. You can call us collect if you are 
an RN who is licensed by examination in Canada or 
a recent graduate from any Canadian School of 
Nursing. Windsor Nurse Placement Service, P.O. 
Box 1133, Great Neck, New York. 11023. (516 - 
"Our 20th Year of World Wide Service" 

United States 

RN's and/or GRAD nunes wanted immediately for 
sunny Florida in active accredited hospital. Reply 
to: Philcan Personnel Consultants at 327-963 I or 
The International Group 324-4932 (24 hour line)- 
B.C. Telex: #0455333. Area Code (604) Vancouver. 

Nursing Positions Available: At a replacement facility 
due to completion in early 1980. Diversified services 
in a small community setting 6 miles from the 
Atlantic Ocean where water sports are a vailable all 
year round. University is within 30 miles where you 
can further your education in nursing. Contact: Mrs. 
B. J. Donnally, Director of Nursing, J. A. Dosher 
Memorial Hospital, South port, North Carolina 
28461 (919) 457-6664 between the hours of 8:00 - 
4:00 p.m. Monday thru Friday. 

Dallu, Houston, Corpus ChristI, etc, etc, etc. The 
eyes of Texas beckon RN's and new grads to 
practice their profession in one of the most 
prosperous areas of the U.S. We represent all size 
hospitals in virtually every Texas and Southwest 
U.S. City, Excellent salaries and paid relocation 
expenses are just two of many super benefits 
offered. We will visit many Canadian cities soon to 
interview and hire. So we may know of your 
interest, won't you contact us today? Call or write: 
Ms, Kennedy, P.O. Box 5844, Arlington. Texas 
76011. (214) 647-0077. 

Come to Tnu - Baptist Hospital of Southeast 
Texas is a 400-bed growth oriented organization 
looking for a few good R.N.'s. We feel that we can 
offer you the chalIenge and opportunity to develop 
and continue your professional growth. We are 
located in Beaumont, a city of lSO,OOO with a small 
town atmosphere but the convenience of the large 
city. We're 30 minutes from the Gulf of Mexico and 
surrounded by beautiful trees and inland lakes. 
Baptist Hospital has a progress salary plan plus a 
liberal fringe package. We will provide your immig- 
ration paperwork cost plus airfare to relocate. For 
additional infonnation, contact: Personnel Ad- 
ministration, Baptist Hospital of Southeast Texas, 
Inc., P.O. Drawer 1S91, Beaumont, Texas 77704. An 
amrmatlve IICtIon employer. 

 - RNs - A choice of locations with 
emphasis on the Sunbelt. You must be licensed by 
examination in Canada. We prepare Visa fonns and 
provide assistance with licensure at no cost to you. 
Write for a free job market survey Or call collect 
(713) 789-1550. Marilyn Blaker, Medex, 5B05 
Richmond, Houston, Texas 77057. All fees employer 

University Faculty 

Applications are invited for clinical faculty 
positions in an integrated baccalaureate 
program. Subject to budgetary approval, 
positions will probably be available for the 
1980-81 academic year in the fields of 
community ,long tenn care, maternal-child and 
Psychiatric nursing. Candidates should have at 
least a Master's degree, demonstrated clinical 
proficiency, teaching and scholarly 
capabilities. Eligibility for registration with the 
College of Nurses of Ontario is essentiaL 
Candidates of both sexes are equally 
encouraged to apply. 
Salary and rank are negotiable and 
commensurate with qualifications and 
professional achievement. 
Interested persons should send a full resume 
and the names of three professional referees to: 

A. J. Baumgart, Dean 
School of Nursing 
Queen's University 
Kingston, Ontario K7L 3N6 
Closing date ofapplications: April I, 1980. 

Before accePti'li any ..... 
position in the .S.A. 
w. Can Off., You: 
A) Selection ot hospitals throughout 
the USA 
B) Extensive Information regarding 
HospitaJ-. Area. Cost of Living. etc. 
C) Complete licensure and Visa Service 
Our Services to you are at 
absolutely no fee to you. 
P.O. Box 1133 Great Neck. N. Y. 11023 
(516) 487-2818 
.. Our 23rd Year of World Wide Service ..... 


Adventure Holidays: Camping Safaris, Overland 
Expeditions and Fun Experiences. We offer trips 
from one week to 3 months in: Canada, USA, 
Europe, Africa, Asia, South and Central America, 
Australia, New Zealand and the Caribbean. For free 
catalogue, apply to: Goway Travel, 53 Yonge St., 
Suite 101, Toronto, Ontario M5E 113. Phone: 
416-863-0799. Telex: 06-219621. 

Nursing in 
the Sunny Palm Beaches 

Picture yourself in the sunny Palm Beaches 
working at the most prestigious hospital in 
Florida. Good Samaritan Hospital has 
maintained the tradition of being the first in the 
latest hospital services and facilities. Our good 
name and outstanding history attest to our 
A 326 bed, J.C.A.H. accredited hospital 
offering attractive salaries and benefits 

. Active in-service orientation 
. Continuing educational programs 
. 37 1/2 hour week 
. 5 day week 
. No shift rotation 
. Education and experience 
. Fully paid Blue Cross/Blue Shield 
. Shift differential and other employee 
. Seasonal employment welcome 
. Patient-mix 90% under age 65 

We will sponsor the appropriate employment 
Visa for qualified applicants. Attractive 
efficiency apartments available at far below 
commercial rates, overlooking the beautiful 
Lake Worth and located across the boulevard 
from the hospital. 


Director of Personnel (305) 655-5511 
Good Samaritan Hospital 
Flagler Drive at Palm Beach Lakes Blvd. 
P.O. Box 3166 
West Palm Beach, Fla. 33402 



These positions are open to both men and womeno Apply 
in writing referring to Competition N umber immediately. 

Director, School of Nursing 
Competition No. NC-937 

The Department of HeaJth and Community Services, 
Institutional Services, Brandon Mental Health Centre 
requires a person to be responsible for organization a;d 
implementation of Psychiatric Nursing education 
programs, including affiliating, refresher and other 
programs; liaising with external agencies in arranging 
academic and field experience; overall supervision and 
direction offaculty and other related activities of the 
School, including general administrative duties and 
involvement in educational research. 

Degree in Nursing with psychiatric nursing experience, 
and several years experience in nursing education 0 

Salary Range: $19,168-$26.168 per annum. 

Assistant Director of Nursing 
Competition No. CN-636 

The Department of Health and Community Services, 
Institutional Services, Brandon Mental Health Centre 
requires a person to be responsible to Director, Nursi
Education for planning, implementation, and assessment 
of a Psychiatric Nursing Diploma program. Duties include 
coordinating activities for both classroom and clinical 
experience, and committee work at middle management 

Baccalaureate degree in nursing with teaching 
experience. Extensive background in psychiatric nursing, 
preferably with RN and RPN licences.- . 

Salary Range: $18,453-$25,152 per annum. 

Chil Service Commission 
340 - 9th Street 
Brandon, Manitoba 
R7N 6C2 


4. \ I. 

Q JC. " 
- .1 \ -, 

, - 

...in Canada's 
Health Service 

Medical Services Branch 
of the Department of 
National Health and Welfare employs some 900 
nurses and the demand grows every day. 
Take the North for example. Community Health 
Nursing is the major role of the nurse in bringing health 
services to Canada's Indian and Eskimo peoples. If )'ou 
have the qualifications and can carry more than the 
nonnalload of responsibility .. \\<hy not find out more? 
Hospital Nurses are needed too in some areas and 
again the North has a continuing demand. 
Then there is Occupational Health Nursing which in- 
cludes counselling and some treatment to federal public 
You could work in one or all of these areas in the 
course of your career. and it is possible to advance to 
senior positions. In addition, there are educational 
opportunities such as in-service training and some 
financial support for educational leave. 
For further infonnation on any, or all, of these career 
opportunities. please contact the Medical Services 
office nearest you or write to: 

I Medical Services Branch 
Department of National Health and Welfare I 
Ottawa, Ontario K1A OL3 
I Address I 
I City Prov I 
I . .. Health and Welfare Sante et Bien-etre social I 
Canada Canada 



Offers R.N.'s 

Ind $500 Inltlll LIVING EXPENSES on a Loan Basis. 
After One Vlar's Service, this Loan Will be Cancelled 

MI American Medical International Inc. 

. Now A.MJ. II ReCflllllng R.N. 'I lor HOlpllalsln TI.as. 
Immldlill Oplnlngl. Sill" Rlngl $11.000 10 $16.500 plr Vllr. 

. You can enjoy nursing In General Medicine Surgery, ICC, 
CCU. Pediatrics and Obstetncs 
. A M.I provides an excellent onentation program. 
in-service training 

. . . 
. U.S. Nurse Recruiter . 
. P.O. Box 17778, Los Angeles, Calif. 90017 . 
I . Without obligatIon please send me more . 
. Inlormation and an Application Form I 
NAME____________ . 
. AOORESS___________ 
. ClTY_ ___ ST.___ ZIP___I 
TELEPHONEI__I_________ . 
. SPECIALTY:__ ____-:____. 

Head Nurse 

Operating Room 

Applications are invited for the above 
afternoon shift position. The Department 
is comprised of 30 surgical theatres 
covering all specialties including open 
heart, neurosurgery and kidney 
transplants. The incumbent would be 
responsible for co-ordinating emergency 
cases and for completion of the elective 

Applicants must have B.C. Registration 
plus a minimum offour years clinical and 
administrative experience. Post basic 
nursing administration course or BSN 
preferred. Demonstrated leadership and 
interpersonal skills essential. Weekends 
and statutory holidays off. Current 1979 
rate $1,500 - $1,772 per month (1980 rates 
under review). Excellent benefits 
including medical, dental coverage and 
four weeks vacation after one year, 

Please submit resume to: 

Mrs. J. MacPhail 
Employee Relations 
Vancouver General Hospital 
855 West 12th Avenue 
Vancouver, B.C. 
V5Z IM9 

Are You a Nurse? 

Nursing Instructors 
Located in the geographic centre of 
beautiful British Columbia the College of 
New Caledonia serves a region of 
120,000 people. Applications are invited 
for positions offull-time Nursing Faculty 
at the College of New Caledonia for the 
1980-81 academic year. 
Qualifications: Applicants must have a 
Baccalaureate Degree and must be 
registered or eligible fOr registration in 
British Columbia. Preferably applicants 
will have two years of nursing practice 
and teaching experience. In particular 
Medical-Surgical Nursing experience is 
Salary: $18,050.00 to $32,450.00 per 
annum. Placement dependent upon 
qualifications. Relocation assistance is 
also available. 
Letters of application with the names of 
three references should be submitted to: 
L. Winthrope 
Personnel Officer 
CoDege of New Caledonia 
3330 - 22nd Avenue 
PrInce George, B.C. 
Phone enquiries to the Personnel Officer 

Surgical Nursing Services 

Here's an Opportunity To Be One. 

Primary Nursing 
.....at the New Regional Hospital means having direct 
responsibility for the nursing care of your patient. his family, 
and working with the doctor as a colleague. 

This 1100 bed community and teaching hospital invites 
applications for the position of Co-ordinator - Surgical 
Nursing Services. The area components are five nursing 
units plus a four bed intensive care unit, totalling 146 

This person will be responsible for the overall delivery of 
quality patient care and management of the surgical 
services including budget control. staffing, staff 
development and other administrative duties. 
Applicants must have an appropriate degree and 
significant clinical experience. 

... . .as a primary nurse means the outcome of your patient's 
care is the measure of your effectiveness. 

.... .results from your role as a professional and the significant 
part you play in the care of your patient. 

PUT IT TOGETHER with the new 300 bed Fort McMurray 
Regional Hospital Opening in November. 1979. 

Please forward a resume detailing experience and 
qualifications to: 

Wan t to know more about your opportunities in our total 
patient care facilities? 

Call Penny Albers at (403) 743-3381 
Write for an information package: 

Personnel Department 
Fort McMurray Regional Hospital 
Fort McMurray, Alberta 
T9H IP2 

Vivian Walwyn 
Employee Relations 
Shaughnessy Hospital 
4500 Oak Street 
Vancouver, B.C. 
V6H 3NI 
(604) 876-6767, local 271 

Registered Nurses 

Corne to work in scenic Comer Brook! 

Registered nurses are needed for this 350 bed Regional General 
Hospital, with detached 60 bed Special Care Unit, serving the 
West Coast of Newfoundland. 

The hospItal offers good fringe benefits such as four weeks 
annual vacation and eight statutory holidays plus birthday 
holiday. In addition there is a hospital pension plan and a group 
insurance plan for all permanent employees. 

Accommodation and assistance with transportation is available. 

Negotiated Salary Scale: 

I January, 1979 - $12,171.00 - 15,429.00 
I January, 1980 - $13,410.00 - 16,199.00 
(Contract not yet signed) 

Service Credits recognized. 

Interested applicants apply to: 

Mrs. Shirley M. Dunph) 
Director of Personnel 
Western Memorial Regional Hospital 
P.O. Box 2005 
Corner Brook, Newfoundland 
AlH 6J7 

Registered Nurses 

1200 hed ho...pital aJ.ia
ent to U ni\ er...it} of 
ampu... offer... employ ment in 
medicine, surgery, pediatrics, 
orthopaedics, obstetrics, psychiatry, 
rehabilitation and extended care including: 
· Inten...i\e care 
· Coronary oh...en at ion unit 
. Cardiovascular ...urgel."y 
· Burn... and pla...tic... 
· f\Jeonatal inten...ivc 
· Renal dialy ...i... 
. '\ieuro-...urgery 

Planned Orientation and In-Service Education Programs 
Post Graduate Clinical Courses in Cardiovascular- 
IDlensive Care Nursing and Operating Room Nursing. 

\ ppl
Hl'cruitment Oflker - 'IIr
I ni\l'p,it
 of .\Ibl'rta Ho'pital 
1<...... - 112th Street 
Edmonton, \lberta 
Tht; 287 



Clinical Nurse Specialist 

Alberta Hospital, Ponoka, a 500 bed accredited active treatment 
psychiatric facility, is now seeking applications from creative 
nurse specialists seeking a challenging career opportunity. 
Duties: Acts as a consultant by assisting the nursing team in 
nursing diagnosis, and by assisting other nurses who are seeking 
new care approaches. Acts as an Educator in order to optimize 
Health Care Standards. Acts as a Change Agent in order to 
improve the quality of care by utilizing skills and theories of 
human relations. Acts as a Researcher by utilizing valid research 
fmdings for patient care and by contributing to research activities 
in order to develop and test concepts and nursing theories. 
Performs other duties as required. 
Qualffications: Graduation from a recognized School of Nursing 
plus considerable related experience, including consultative 
experience. Must be eligible for registration in an Alberta 
Association. Equivalencies considered. Baccalaureate or 
Masters Degree in Mental Health and/or Behavioural Sciences 
Salary: $18,024 - $22,596 
Competition #9212-5 This competition will remain open until 
a suitable candidate has been selected. 

Apply to: 
Alberta Hospital 
Box 1000 
Ponoka Alberta 


University of 
Alberta Hospital 

Edmonton, Alberta 


Th. . . I. 

Overseas Opportunities 
cusa has openings tor public health 
nurses and nursing instructors in Africa 
and Pdpua :'lie" Guinea. Applicanh must 
ha\e Canadian 4ualificdtions and be pre- 
pdred to "ork "ith limited supplies and 
e4uipment. r ra\eI is an important com- 
ponent of communit
 health care "ork. 
"hile nurse instructors are usuall\ 
aUdched to nursing colleges. . 
Qualifications: Degree and or Public 
sin.!! experience is essential. 
Cont,act: 2 \ ears. 
Sala,}'." l 0" b\ Canadidn standards but 
sullicient lor dn ade4uate lilcsl\ Ie. 
Couples will be considered It there are 
positions for both pdrtners. 
!-or more mlorrnatlon. "me: 
Cl'SO Health-DI Program 
151 Slatcr Street 
OUd"d.Ont KIP 5H5 

The Grande Prairie Hospital 
Complex is recruiting full-time 
and casual nurses. 

Current vacancies are in 
Out-Patients, Intensive Care, 
Medica], and Auxiliary. 

Anticipated vacancies in other 
Apply to: 
Personnel Director 
Grande Prairie Hospital 
10409 - 98 Street 
Grande Prairie, Alberta 
T8V 2E8 
Telephone: 532-7711, 
Extension 78 

Waterford Hospital 
Career Opportunities For 
Registered Nurses 

 Waterford Ho..pmtl. ê:I fully accredited-JOO 
bed P'l.ychlatnc In!iotllullon. affihdlcd with 
Mcmonall'nivcnil) School ofN ur..mg and 
Medical School. hd!t opemng... for Rr'l
NuntC"ii 'n all servicC''!.. including new. 
nd acute carC' 'iC'nlcc"," 
.<\n orientation progr
m., offrrC'd 
Sdlary i... on the ..calc ofSI2.04
 - 14, "i5Cj per 
annum A Psychlalm: 
C .a:.llow"ncc of 
S 1,119 per annum i'l. 8"dllablc III dt1dltlOn 10 
basit: salary. Both ...alary dnd "UoVo <:Ince 
presenlly under reVlcw 
The HO"PIIWI't close 10 wi a",enllu
..hopping. tran
po"arlOn ",nd reCreal.on 
Accommodation... avallablc in HO'tpltal 
Rcsldcncc <:II nominal ,"o..t 
ApphcatlOn.. In wnllng ..hould tie dddre....ed to 
the under..igncd. 
....rwnnel Dirt('tor 
\\.terford H
\\'lIterrord Bridlf' Road 
Sf;. John '5. 
Telephone NUmber
 (709) .J68-606I. ext. 341 

sa F_...... 1MO 

Part Time 
Hospital Representatives 
Moalreal Toroato 

Vaøc:ouver Edmonton 
Retina Cel.acy 

We are a new company formed to sell 
specialized equipment and apparatus primarily 
to H..pltall ..d CIIDlco. 
We need pan time representatives in the above 
seven territories and invite applications from 
qualified nurses. or persons with a suitable 
medical auxiliary qualification. who are keen 
to sell for about four (4) hours per day. Full 
training wm be given in all aspects of our 
limited but technical product line. 
We wm provide a car and we will pay good 
commission on all sales achieved. 
This is a unique opportunity particl}larly for 
mature people. with suitable medical 
backgrounds. 10 embark on a new and 
rewarding career pathway. despite some daily 
domestic commitments. 
Plcase send your resume to: 
Clrcomedk Laboretorles Umlted 
12Z1I! Yoage Slnet 
Rlchmoad Hili, Ontario L4C 4\1> 

Royal Jubilee Hospital 
Vktorla, B.C. 

Applications are invited from Registered 
Nurses or those eligible for B.C. Registration 
with recent nursing experience. 

Positions are available in all services of this 
9S0 bed accredited hospital which includes 
Acute and Specialty Care. Obstetrics and 
Paediatrics. Psychiatry and Extended Care for 
Full Time, Part Time and Casual Employment 

Benefits in accordance with R.N.A.B.C. 
contract . 

Please send resume to: 

Director of Nursing 
Royal Jubilee Hospital 
1900 Fort St. 
Vktorla, B. C. 
V8R U8 

Registered Nurses 

418 bed fully-accredited general hospital in 
Sudbury is looking for nurses who are willing 
to be challenged with a wide variety of nursing 
Candidates must be eligible for registrallon 
with the Ontario College of Nurses. 
Bilingualism is a definite asset. 
Positions are opened for medical/surgical, 
rehabilitation and long-term care for full-time 
and part-time employees immediately; and 
part-lime in our Renal Dialysis Unit. More 
positions will be available in January due to the 
expansion of our Long Term Care Program. 
Salary: according to O.N .A. contract 
Please apply in writing to: 
Director of Puoonnel 
Hôpltal Laurentlen - Laurentian Hospital 
41, ch. du lac RalmeY 
Sudbury, Ontario 

Th. ("...nAlt..n Nur... 

International Grenfell A

Registered Nurses, Public Health 
Nurses and Nurse-Midwives 
for Northern Newfoundland and Labrador 
The Internatlondl Grenfell A
provides Medical Service, in Nonhern 
Newfoundland and Labrador. II slaft__ 
four ho
. seventeen nursins 
""tdtions dnd many public hedlth unih. 
Our main hospital is a 150 bed dccredited 
pita.1 ...ituated in scenic St. Anthony. 
Newfoundland. Active treatment is 
carried on in Surge!)'. P...ychidt!)'. 
'\Iedicine, Pedidlrics. 085/G\ N. and 
OrientdtlOn dnd dctlve In
Progrdm provided for stafT. Salary ba-ed 
on government scales; 37 II"! hr
. per 
week. Rotdtins ...hift'i. Excellent 
personnel benefils include liberal 
Vdcdtion dnd 
ick leave. Accommodation 
dvaildhle. Return air fare paid on d 
completion of a one yedr ...ervice. 
Apply 10' 
Scot! Smith 

rsonnel Director 
Curtis Memorial Hmpital 
International Grrnfell ASMK'iation 
St. Anthon
. I'oewfoundland -\OK 4S0 

Registered Nurses 

Shaughnessy Hospital is an 1100 bed 
multi-level teaching hospital. We offer 
RC. Registered Nurses the following 
employment opportunities. 
. Full-time. part-time or on-call 
positions: Spinal Cord Injury Unit, 
Intensive Care areas, Rehabilitation and 
Assessment, Long Term Care, 
Psychiatry, Medical and Surgical. 
Please apply in writing or phone: 

Vivian Walwvn 
Empioyee ReÍations 
Shaughnessy Hospital 
4500 Oak Street 
Vancouver, B.C. 
V6H 3NI 

(604) 876-6767, local 271 

.... Director of Nursing 

Palmu.ton and Dlstrkt H...pltal 
Applications are invited for the position of 
Director of Nursing of this fully accredited 40 
bed active treatment Hospital. 
The Direclor ofNur,mg IS dlreclly responsible 
to the Admimstrator for the quality of nursing 
Cdrc, the development and maintenance of the 
nur'iing care program. the overall 
admini'itration and staffing of patient service
of the unit including O. R. and ambulatory care 
The appllcanl must be eligIble for reglSlrallon 
in the Province of Ontario. 
The selection will place strong emphasi
 on the 
 philosophy of administration and 
the applicanb combination of demonstrated 
administrdtive skl1l
. appropriate experience 
and educational background. 
Please ...end confidential re
ume to: 
Mr. R. G. Emmuson 
Palmu.ton end District H...pltel 
P.O. Box 130 
Palmerston. Ontario 'l/OG 2PO 


- .- 

Assistant Director 
Nursing Service 

The Calgary General Hospital invites applications for the 
position of assistant director for the Division of Obstetrics, 
Gynecology. and Pediatrics in the Department ofN
rsi.ng . 
Service. This Division consists of six (6) nursing UßIts, mcludmg 
an Intensive Care Nursery and has a total of 180 beds and 65 
bassinettes. The Division is committed to the family centred 
approach to patient care. 
The successful applicant will be a registered nurse with advanced 
preparation and considerable experience at the supervisory or 
management level. 

The 1979 salary range for this position is from $2 1.760 to $24, I 80 
per year and is subject to review in January. 1980. A 
comprehensive range of employee benefits is offered including 
full family dental care. 

Applications, with a detailed resume of education and 
experience. may be submitted in confidence to: 

Director of Pusonnel 
Calgary General Hospital 
841 Centre Avenue East 
Calgary, Albena T2E OAI 




Join u
 at one of the three Hospitals of the South 
Saskatchewan Hospital Centre. Regina. 
- Provincial Capital 
- University Centre 
Nursing Areds: - Intensive Care - Plastics 
- :\1edicine - Psychiatry 
- Chronic Care - Obstetrics _ Rehabilitation 
- Coronary Care - Orthopaedics _ Surgery 
- Emergency - Paediatrics _ Urology 
Interested applicants should be eligible for 
registration in Saskatchewan. 
For further infonnation on nursing opportunities 
write 10: 

ursing Recruitment Officer 
South Saskatche"an Hospital Centre 
.UOI l)e"dne} Avenue 
Regina. Saskatche" an S.ff I AS 




P rovo 

Postal Code 



0PPamNTY 4lR 


Applications are invited for positions at Alberta Hospital, 
Edmonton, a 650 bed active treatment psychiatric hospital, 
located 4 km. outside of Edmonton. 
Successful candidates must be graduates from a recognized 
School of Nursing and eligible for registration in their 
professional association; willing to work shifts. Vacancies exist 
in Admissions, Forensic. Rehabilitation, and Geriatric Serviceso 
Note: Transportation is available to and from Edmonton. 
Accommodation is available in the Staff Residence. 

Salary $1,229- $1,445 per month (Starting salary based on 
experience and education) 

Competition #9184-9 
This competition will remam open until a suitable candidate has 
been selected. 

Qualified persons are invited to phone, write or submit 
applications to: 

Pusonnel Administrator 
Albena Hospital, Edmonton 
Box 307, Edmonton. Albena 
TSJ 2J7 
Telephone: (40J) 97J-22IJ 



Public Service 

Psychiatric I Mental Health Nursing Consultant 

Duties: Maintains a working relationship with community 
agencies and government departments involved with mental 
health programs, the position acts as consultant in the 
developmental, administrative and clinical aspects of psychiatric 
nursing in hospital based programs in the province and assists in 
the development of professional standards for education and 

Qualifications: Experience in Psychiatric nursing, a master's 
degree in psychiatric nursing, eligibility to register as a nurse in 
the province of Newfoundland or any equivalent combination of 
experience and training. 

Salary: $22,761 - $28,178 (EFFECTIVE January I. 19801 

Competition 'l/umber: H. PNC 190 

Financial Assistance towards relocation is available 

Applications may be submitted in confidence to: 

Public Service Commission 
16 Forest Road 
St. John's, Newfoundland 
AIC 289 

This Competition is open to both men and women. 



Government of 
Newfoundland & Labrador 

Public Notice 

Cottage Hospital Nurse l's 

Applications are invited for appointment on a permanent or 
short term basis to the Nursing Staff of the Cottage Hospitals 

Bonne Bay 

Harbour Breton 

Salary for Cottage Hospital Nurse I, annual, sick leave, 
statutory holidays and other fringe benefits in accordance 
with Nurses Collective Agreement. 

Living-in accommodations available at reasonable rates, also 
laundry services provided. 

Applications should be addressed to: 

Director of Nursing 
Cottage Hospitals Division 
Department of Health 
Confederation Building 
St. John's, Newfoundland 
AIC S1'7 

Lome A. Klippert, M.D. 
Deputy Minister 

The University of Lethbridge 

invites applications and nominations for 

Director of the School of Nursing 

The School will develop and offer a post-basic 
baccalaureate program leading to a Bachelor of 
Nursing degree. 
Desirable qualifications include: 
1. an advanced degree and experience in 
2. experience in Nursing education and 
curriculum development at the University 
3. the capability of dealing effectively with 
external organizations involved in health care 
education and delivery. 
The appointment will commence on July 1, 1980 or 
Applications and nominations will be accepted until 
February 28, 1980, and should be sent to: 


Vice-President (Academic) 
University of Lethbridge 
4401 University Drive 
Lethbridge, Alberta 
T1 K 3M4 

8' .f.


Head Nurse 

Spinal Cord Injury Unit 

The Spinal Cord Injury Unit is a tertiary care referral 
center. We take a multi-disciplinary team approach to 
patient care. . 

This is a challenging career opportunity for an individual 
who will be responsible for the management of a 22 bed 
area which includes an Intensive Care Unit. Preference 
will be given to applicants with a Baccalaureate degree 

[fyou have: 

. proven administrative experience in a Head Nurse 
. effective communication skills, 
· proven abilities in leading and developing staff, 
. and clinical expertise in neurology, neurosurgery or 
orthopedics.... .. 

Please apply, including a resume to: 

Vivian Walwyn 
Employee Relations 
Shaughnessy Hospital 
4500 Oak Street 
Vancouver, B.C., V6H 3NI 
876-6767, local 271 

Director of Nursing 

Applications are invited for this senior management 
position in a fully accredited multi-disciplinary treatment 
complex of 406 beds, including extensive out patient 
programmes. Reporting to the Executive Director, fully 
responsible for organization, planning, administration and 
operations of nursing care functions. 

Candidates must have current registration in Ontario, 
B.Sc.N. or Masters degree preferable, with demonstrated 
competent leadership abilities and previous nursing 
administrative experience at a senior level. 

Applicants are requested to submit a comprehensive 
resume and salary expectations to: 

G. E. Pickard 
Executive Director 
Windsor Western Hospital Centre Inc. 
1453 Prince Road 
Windsor, Ontario 

9C 3Z4 




Nursing Opportunities in Vancouver 
Vancouver General Hospital 
If you are a Registered Nurse in search of a chanlle and a challenge - 
look into nursill8 opportunities at Vancouver General Hospital, B.C. 's 
mllior medical centre on Canada's unconventional West Coast. Staffill8 
expansion has resulted in many new nursill8 positions at all levels. 

General Duty ($1305. - 1542.00 per mo.) 
Nurse Clinician 
Nurse Educator 
Recent graduates and experienced professionals alike wiJI find a wide 
variety of positions available which could provide the opponunity 
you've been Iookinll for. 
For tlJose with an interest in specialization, challenges await in many 
areas such as: 

Neonatology Nursing 

Intensive Care 
(General & Neurosurgical) 
Cardio- Thoracic Surgery 

Inservice Education 

Coronary Care Unit 
Renal Dialysis & Transplantation 

Burn Unit 

If you are a Nurse considerill8 a move please submit resume to: 
Mrs. J. MacPbaII 
Employee Relations 
V IIJIcouver General Hospital 
855 West 12th Avenue 
Vancouver, B.C. V5Z IM9 

Director of N IIrsing 

The Holy Cross Hospital, a 500 bed fully accredited hospital with 
regional Cardiovascular services in Southern Alberta invites 
applications for the position of Director of Nursing. 

The Director of Nursing is responsible for administration and 
professional activities of the Nursing Department. This position 
requires leadership in planning, developing and evaluating 
nursing programs. This leader also assumes responsibility for 
Quality assurance of nursing practice throughout the hospital. 

Quallftcations: Registered in the Province of Albena. A Master's 
degree preferred but consideration will be given to a 
baccalaureate candidate. The successful candidate will have 
demonstrated leadership abilities and accomplishments with 
progressive and creative approach. 

Experience: A minimum of S years' progressive nursing 

Please send a complete resume indicating Qualifications, 
experience, date available and salary expected to: 

Director or Personnel 
Personnel Depanment 
Hospital District #93 
9<<1- tlh Avenue S. W. 
Calgary, Albena T2P 1U8 

General and Psychiatric Nurses 
Hong Kong Up to HK$3,745 p.m. 


Applications are invited for appointment as 
Registered General Nurses or Registered Psychi- 
atric Nurses. Successful candidates will perform 
nursing and supervisory duties in Government 
hospitals and cl.inics in Hong Kong. 
Qualifications required:- 
A. (i) General Nurse:- 
Certificate of Registration (Part I) issued by 
the Nursing Board of Hong Kong. 
(ii) Psychiatric 
Certificate of Registration (Part II) issued 
by the Nursing Board of Hong Kong. 
B. Fluent Cantonese essential; knowledge of 
other Chinese dialects an advantage. 
C. Applicants possessing other professional 
qualifications should enclose detailed tran- 
script of their nursing training and state 
qualifications obtained in their applications. 

.., . 



." - 


Salary scale:- 
(i) General Nurse: HK$2,46S to HK$3,S6S p.m. 
(ii) Psychiatric Nurse: HK$2,6oS to HK$3,745 
g salary will depend on post-qualification 
Successful candidates will be appointed on 
probation for two years and if their service is 
satisfactory, they will be confirmed to the 
permanent and pensionable establishment. They 
will be provided with a passage to Hong Kong 
plus a baggage allowance. Other benefits include 
generous paid leave, medical and dental attention, 
free uniform and laundry and in appropriate 
cases, education allowances for children. 
Applicants should send full resume of training, 
qualifications and experience to the Hong Kong 
Government Office, 6 Grafton St., London WI X 
3 LB , England before 29th February, 19 80 . 

Hong Kong Government 


An Emergency Nursing 
Symposium will be held at the 
University of Calgary, February 
20-21. Contact: Mary Hammond, 
Coordinator, Continuing 
EducationforNurses, University 
of Calgary , 2920 24Ave. NoW., 
Calgary, Alberta, T2N IN4. 
.. A Day In Rehabilitation", a 
seminar for nurses, therapists and 
physicians, will be held February 
20 at the Oshawa General 
Hospital. Contact: M. Papp, 
Oshawa General Hospital, 24 
Alma St., Oshawa, Ontario, 
L1G 2B9. 
The Learning Disabled: A 
Community Affair is a seminar 
presented by Simon Fraser 
University, February 21-23 at the 
Bayshore Inn, Vancouver. 
Contact: Continuing Studies, 
Simon Fraser University, 
Burnaby, B.C., V5A IS6. 
Occupational Health. Toxic Agents, 
a five-day seminar will be held at 
the Citadel Inn in Halifax, N .5. on 
February 25-29 and will be 
repeated in Toronto, March 24-28. 

Contact: Cortference & Seminar 
Services, Humber College, Box 
1900, Rexdale, Ontario, 
M9W 5L7. 

Critical Care Nursing, Levell, 
designed for registered nurses 
working in a non-specialized 
critical care unit, will be offered in I 
Nanaimo, March 17-Apri121 and 
in Vancouver, April30-June 3. 
This course requires 60 hours of 
pre-course independent learning 
and five weeks of concentrated 
classroom and clinical study. 
Contact: (for the Nanaimo 
course) Division of Continuing 
Nursing Education, P.A. 
Woodward,JRC, University of 
British Columbia, Vancouver, 
B.C., V6T lW5 or (for the 
Vancouver course) Continuing 
Education, Vancouver 
Community College, Langara 
Campus, 100 West 49th Avenue, 
Vancouver,B.C., V5Y 2Z6. 

Nursing Jftb Fair 
Looking for a job Now or Later? 
The Second Annual Toronto Area 


...Over 5,000 nursing positions at 70 hospitals and medical centers 
from all over the U.S. and Canada. The NURSING JOB FAIR nursing 
employment convention will be held February 21 - 23 at the Toronto 
Harbour Castle Hilton, One Harbour Square. Admission is FREE to all in 
the nursing profe
sion-LPNs, all RNs with diplomas, AS, BSN, MSN, and 
all students, administration and faculty. An open Invitation is provided 
Come and find out what kind of nursing positions and opportunities 
are available. Learn about living conditions, education reimbursement 
plans, relocation assistance and nursing innovations. 
The NURSING JOB FAIR runs three (3) days, February 21 - 22 
(Thursday and Friday) from 10 a.m. to 7 p.m.; Saturday, February 23 from 
9 a.m. to 2 p.m. 
On Thursday and Friday a one-hour Career Seminar will be given at the 
convention by Bernard J. Smith, RN, MSN, (former assistant Professor of 
Nursing) for all nursing students at 9 a.m.. 12 noon. and 3 p.m.; and for 
experienced nurses at 10:30 a.m., 1:30 p.m., and 4:30 p.rn. The Career 
Seminar is free of charge and covers all aspects of nursing career 
Come alone or with a busload of friends, but don't miss this once-a- 
year chance to meet representatives from over 80 hospitals and medical 
centers and discuss your long and short term nursing employment 
interests and needs. 
Hospitals and Medical Centers attending from the U.S. are from the 
states of: Alabama, California, Washington D.C., Florida. Georgia, 
Indiana, Louisiana, Maine, Maryland, Michigan, New Mexico, Nevada, 
North Carolina. Ohio, Pennsylvania. Tennessee, Texas. Utah. and 
facilities from the Toronto area. 
Sponsored as a service of NURSING JOB NEWS monthly newspaper 
for the nursing profession. 470 Boston Post Road, Weston. MA 02193. 
For further subscription and convention information call 1 (617) 
: "-2702,9 - 5 weekdays. 1980 PNPC 


Index to 
February 1980 

Ames Division, Miles Laboratories Limited 
Baxter Laboratories 
The Canadian Nurse's Cap Reg'd 
Canadian School of Management 
Career Dress (A Division of 
White Sister Unifonn Inc.) 
The Clinic Shoemakers 
Department of National Defence 
Equity Medical Supply Company 
Frank W. Horner Limited 
JoB. Lippincott Company of Canada Limited 
Nursing Job Fair 
Phannacia (Canada) Limited 
Posey Company 
The Procter & Gamble Company 
W.B. Saunders Company 
Schering Canada Inc. 
G .0. Searle & Company Limited 
Up john Hea)th Care Services 


10, 47 
6, 7, IBC 

Advertising Repre.

Jean MaIboeuf 
60 I , Côte Vertu 
St-Laurent, Québec H4L IX8 
Téléphone: (514) 748-6561 

Gordon Tiffin 
190 Main Street 
Unionville, Ontario UR 2G9 
Telephone: (416) 297-2030 

Richard P. Wilson 
PoO. Box 482 
Ardmore, Pennsylvania 19003 
Telephone: (215) 363-6063 

Member of Canadian 
Circulations Audit Board Inc. 

Advertising Manager 

Gerry Kavanaugh 
The Canadian Nurse 
50 The Driveway 
Ottawa, Ontario K2P I E2 
Telephone: (613) 237-2133 


." e.........__.1I6Aft 

I..' "W.. 



a new skin moisturizing lotion that merits 
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. Healing help for dry skin 
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. Clinically proven effectiveness 
Three SI \ J<., double-blind clinical studies 
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WOl'-D "was significantly effective in 
ailE tllllg dry skin problems. 

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. Cosmetil ' 
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moisturizing lotio r personal trial. 


IPlease print dearly) 





Postal Code 

I J 
\ l 

A traditional family approach 
to cold rehef. 







! I \ 
I " 1 

For over a quarter of a century, 
Coricidin has been a tradjtjona 
approach to relieving cold 
symptoms... with Canadian 
nurses and families alike. 
Coricidin, a combination of a 
trusted analgesic. dntihistamin 
and an effective decongestant ( 
Coril'idin '0'*). offt'rs a produc 
form for virtually t'very age gro 
Pediatric drops are available fo 
children two years rind over; 
chewable Medilets* for childrt' 
up to the age of 12; dnd Coricid 
and Coricidin 'D' for teenagers 
and adults. 
We would like to tell you what 
we've learrlt'd ahout colds It's ( 
in a comprehensive 20 pagt. 00 
let compiled specially for nurs 
"How to nurse a Cold" answers 
most of the questions you face 
every day: 
- What exactly is a cold'! 
- Do children get more ('old 
than adults',', 
- Are some serious disease. 
easily confused with thl' 
common cold? 
Send for your free copy of "Ho 
Nurst' a Cold" 

Full Inlormahon " puhhsh..d In Iho' lomp"I1' 
01 Pharrnao ..utll al. and Spo'o ".Iho's and ,lV.1I1 
on rl'qu..st 'rom St ho'rlll\! l'andda Ino Poinh 
l1dirl' .I.}u..ht'. H!IR I B4 

'RHì TM. c=:J c=J 



(1 .;:_::; 
... En nombr. 
lion! lrot_ 
e.... c..... 
· Canada's national nurslnCl 
journal celebrates Its 75th 
· Guillaln-Barré Syndrome - 
how it affects the nurse, patient 
and family 
· Dispelling the mystique that 
surrounds Legionnaire's 
· Assisting bereaved parents 








1 M ;; 261980 
, N:"'I '

MARCH 1980 





J' ---- 
\ ,\ 
( . '-. 





Beautiful Royale Silcotta. Luxurious woven 80% Polyester. 20.. . .tton. 



\ \ , J .1\ I 
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ional inspection di.ision. Order 
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Change of Address: Notice should be 
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t-anddlan Nurses Association. 50The 
Dn\eWdv. Ottdwd, Cdnada, "

With this March issue. CNJ 
celebrates 75 years of 
with the nurses of Canada. 
Our cover photo, taken in 
1905. the year the first issue 
appeared, is of a nurse al the 
Lakeside Home for Little 
Children located on Toronto 
Island, Toronto, Ontario. 
Photo cout1esy Public 
Archives Canada, C-91 153. 







March 1980 

Volume 76, Number 3 

The official journal of the Cdnadidn Nurses Association 
published in French and En8li
h editions eleven times per 



.. . 



Dla.-ð Jubilee . . . . . . . . . . .10 

Blrtb room ...............30 

VoIUDlftrSOD OB..........38 

14 YOU AND THE LA \\ 34 Letting go 
Consent. sterilization and mental Sheila Parrish 
incompetence: the ca
 of" Eve" 
Corinne Sklar 
20 CNJ's 75th anniversary 38 When experience counts 
A ('apsule history of your journal Syl
'ia Segal 
A lillie crystal ball gazing 
26 Guillain-&rre S)ndrome 40 A postpønum program that works 
Laura Barry KalhleenFreeman 
30 The Birth Room 43 Institutionalization 
Ellen L. Rosen Barbara Haynes 
33 An open letter to the nurses of Canada 46 Legionnaire's disease: an old enemy 
Jane Meh'il/e White with a new name 
ErnaJ. Schilder 
5 Perspective 9 News 11 CNA annual 
6 Input 11 Calendar 54 Books 

Thf' C ulludim, N "rse welcomes suggestions for anicles 
or unsolicited manuscripts. Authors may ,ubmit 
finished anicles or a summary of the proposed 
content. Manuscripts should be typed double-spaced. 
Send original and carbon. All anicles must be 
submitted for the exclusive use of The Cmlt/dilln 
Nursf'. A biographIcal ,tdtement and rei urn dddre" 
should dcCompany dll mdnuscripts. 

The views expressed in the anicles dre those of the 
authors and do not necessdrily represent the policies of 
the Canadian Nurses Associdtion. 


I ndexed in I nterndtional Nursing Index. Cu mulative 
Index to Nursing Literature. Abstracts of Hospitdl 
Management Studies. Hospitdl Literdture Index. 
Hospital '\bstrdcts. Index Medicus. Cdnadian 
Periodical Index. The Cunlldilll,.v"rse is aVdilable in 
microform from Xerox University \1icromms. Ann 
Arbor. Michigan 48106. 

(Í.ïCanddian Nurse, A"o<.:idtion. 19110. 





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The stereotypes are 
everywhere: on the soap 
operas of daytime television, 
nurses are damp-eyed 
creatures who pine for the 
love of the nearest eligible 
doctor; a television 
commercial several years ago 
advertising a well-known 
toilet bowl cleaner featured an 
actress dressed as a nurse 
claiming, "We don't fool 
around, we use a 
professional!"; heart-throb 
fiction churned out by the 
paperback thousands centers 
on nurse-heroines in love with 
doctors who remain oblivious 
to their charms. A movie 
theatre in Hull, Quebec, 
features a film entitled "Des 
infirmières très privées" (very 
private nurses) with the 
caption 'find out what to do 
until the doctor comes!' 
There can't be a nurse 
who hasn't seen and been 
annoyed by the image of 
nurses in the media - the 
nurse of stage, screen and 
paperback is a weak-willed 
creature who relies on the 
doctor for direction, both 
personal and professional, and 
whose only real aim in life is 
to find some nice man, get 
married and have children. 
We don't believe in these 
stereotypes, but does the 
average member of the 
public? Do doctors? Several 
recent studies say no. 
A study in the United 
States quizzed a number of 
people about what they 
thought nurses' jobs really 
involved and how much 
education they had to have. 
The result was. according to 
Nursing Outlook, "the public 
as represented by these 
respondents generally 
believed that nurses are better 
educated than they actually 
areo" An informal survey 
conducted by Nursing last 
year asked doctors and nurses 
for their opinions on the 
nursing profession and came 
to the somewhat startling 
conclusion that doctors often 
have a higher opinion of 
nurses than nurses do. One 
statement the nurses made 
was doctors don't have the 
slightest idea of the care we 
give, adding that they thought 

Mirror, Mirror on the Wall 
A look at nursing
s image - now and in the future 

they spent more than 50 per 
cent of their time doing direct 
patient care. The doctors 
surveyed agreed. Countering 
the assumption that doctors 
viewed nurses as assistants, 
not colleagues, was the 
information that the 225 
doctors surveyed ranked 
nurses higher in their esteem 
than the other helping 
professions such as 
pharmacists, dietitians or 
hospital administrators. 
What does all this mean? 
That nursing 'doth protest too 
much' ? 
The roots of nurses' 
rather discouraging tendency 
to downgrade their own 
profession probably lie in the 
history of the nursing 
profession as a whole. I tis 
true that the first nurses were 
often prostitutes or at least 
vulgar women who did not 
mind doing physical tasks for 
other people. It is also true 
that the profession has 
traditionally been made up 
chiefly of women. This 
explains a great deal. As 
MaIjorie Keller wrote in her 
essay on the effect of sexual 
stereotyping on the 
development of nursing 
theory, the stereotype has 
been that women's work was 
non-intellectual and centered 
in practice: "Perhaps nursing 
was long considered a practice 
discipline not only because it 
was practiced by women, but 
also because it was slow to 
move into universities." She 
added that women have 
historically tended to 
downgrade or underplay their 
intellectual abilities and to 
display "excessive humility" 0 
True enough, many a 
nurse can recall being 
discouraged by her family and 
friends from going into 
nursing because of the feeling 
that she would be wasting her 
intellect - "You're too smart 
to be a nurse." Denise Benton 
wrote in "You Want to Be 
a What?" that "nursing has a 
history of attracting applicants 
by a passive rather than active 
choice. .. 
It does not help that 
nursing itself is divided today 
on the question of what 
nursing really is. Many feel 

that the only 'real' nursing is 
direct bedside care of the sick; 
others see the development of 
nursing theory and research as 
a priority. There is some 
suggestion that the nurses 
produced by the educational 
systems today are not as 
'good' as in the old days, that 
they do not have the same 
sense of devotion or 
dedication. If this is true, is it 
the fault of nursing programs, 
or merely a reflection of the 
kind of people going into them 
today? As one nurse admitted, 
no young woman in her right 
mind would volunteer today 
for the hospital-based 
programs of twenty years ago 
The profession has 
undergone enormous changes; 
it will probably see many 
moreolt must if it is to 
survive, say many educators. 
An excerpt from the book 
Nurse by Peggy Anderson 
telescopes the 
"Another problem for 
many nurses is that nursing is 
undefined. What is a nurse? 
Nurses have been debating 
that question for years. A 
nurse used to be a physician's 
handmaiden. My husband's 
grandfather.. ore membered a 
time when nurses stood up 
and saluted doctors. Central's 
director of nursing, a woman 
in her forties. remembers the 
days when nurses had to stand 
and give doctors their chairs 
when they came into the 
"This attitude has not 
disappeared. But nurses are 
stepping out of that 
mold...Many nurses want to 
bring their own intelligence to 
the job and are becoming 
more aggressive about doing 
so. I think a nurse must make 
decisions that affect what 
she's doingo Ifshe's a robot, 
she's nothing." 
There are many nurses 
who welcome this change and 
the accompanying increase in 
responsibility, but there are 
others who are content tojust 
'do the job', grouse about how 
little the public and doctors 
seem to think of nurses, and 
go home to their social lives. 
There are those who actually 

impose negative sanctions on 
their colleagues who want to 
improve themselves or who 
have an obvious need to learn. 
A staff nurse tells of how she 
was discouraged by other 
nurses on her floor from going 
to see a cardiac 
catheterization with one of her 
patients; she had never seen 
one and it was quite a 
common procedure on her 
unit. Her colleagues asked, 
"What do you want to do that 
for?" , and the head nurse was 
reluctant to grant her the time 
off the ward. Benton 
emphasizes this in her paper, 
saying that nurses tend to 
exert pressure which "serves 
to deny individual nurses' 
rights and responsibilities to 
develop their interests and 
abilities to their fullest 
potential, for the ultimate 
benefit of the health care 
consumer. " 
Alice Baumgart, dean of 
Queens University's School 
of Nursing, made note of this 
idea in a speech to the RNAO 
last year, and added that 
nurses need to support each 
other through informal 
networks to help build and 
reinforce professional 
It is clear then, for 
whatever reasons, that the 
blurred image of the nurse 
reflected in popular literature 
and television is perhaps a 
reflection of how nurses still 
see themselves - someone 
who is there, who can be 
molded into whatever the 
situation requires of her. but 
whose aims and personal 
goals may not always be 
"Nursing is changing, 
and we can make it whatever 
we want it to be," Principal 
Nursing Officer Josephine 
Flaherty told nurses at CNA's 
Nursing Education Forum last 
year. Her words might serve 
as a guideline for nurses in the 
years to come: if it's an image 
change we want, we're the 
onl y ones who can do it. 'V 

Jane Bock 

:Tb __CIInadllon Nur.. 

lI.reh 1 MO 5 

Help for D.S. parents 
As a nurse with a 
two-year-old foster Down's 
Syndrome child, I must 
commend The Canadian 
Nurse for publishing an 
up-to-date report on a 
syndrome surrounded by 
pre-conceived prejudices. I'm 
sorry it didn't appear sooner! 
Living in a remote region 
of B.c., we have had to 
actively look for the support 
services and resources to help 
us care for the baby we've had 
since the age ofthree weeks. 
As recently as 1977, we were 
given information that 
emphasized the negative 
rather than the positive 
aspects ofD.S.: his parents 
received little encouragement 
to keep him. 
We heard about the 
Experimental Education 
Unit's work with Down's 
Syndrome at the University of 
Washington, Seattle and the 
information and 


encouragement obtained 
from them has been 
invaluable: I would highly 
recommend contact with this 
model program for any new 
parent with a D. So baby. 
Our active two-year-old 
has developed into a curious 
little boy who is a pleasure to 
know and work with. Early 
education intervention does 
make a difference, and there is 
indeed a "new image" of 
Down's Syndrome. 

S. Coolbaugh, RN, Fernie, 

Saints or sinners 
It is with great pain and 
distress I read about the 
situation in Ontario ("You 
and the law" November); 
thank you for bringing it to my 
For me it epitomises the 
problem of hospital nursing- 
we the caregivers are 

Students & Graduates 



impotent "mops" for all the 
wrongs in the health care 
delivery system. 
Any nurse who wishes to 
stay (in the hospital situation) 
in a so-called profession 
which prevents her/him from 
executing her/his trained 
liefs and acquired related 
knowledge is either a 
masochist. a victim of sex role 
stereotyping or really into the 
"plug in for a paycheque" 
I say to the l.c. U. nurses 
of Mount Sinai "right on" and 
to the Canadian Nurses 
Association "wake up now" 
to the parody of a profession. 
-Helen L. Morgan, Victoria, 

A labor oflove 
Midwifery has long been 
recognized as a specialized 
facet of nursing as evidenced 
through the additional studies, 
training and practice required. 
Employers, through 
specifications in their 
advertisements for staff, also 
recognize it. Yet the 
remuneration for such 
service, awarded by all of the 
major hospitals in this city, is 
a paltry $2. 15 per week on top 
of our regular salary. 
Midwives in northern 
areas of our country. where 
doctors are not readily 
available, provide complete 
medical attention throughout 
the maternity cycle. In our 
high risk maternity case 
rooms, and in most delivery 
suites in Edmonton, the 
nurse/midwife supervises 
both normal and complicated 
labors; she institutes required 
preventive or remedial 
measures and, when the 
doctor is absent, acts in 
Our employment requires 
shift work and irregular days 
off, work hours that are only 
required of those providing 
emergency servIces 0 
Fortunately recompense 
is obtainable in the knowledge 
that we provide an essential 
service, in friendships formed 
with co-workers and in the 
acknowledgements of our 

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patients. The extra 
remuneration probably would 
not excite the newspaper 
delivery boy. 
Perhaps the time has 
come for a concerted effort on 
our part. Are we 
professionalism at the 
expense of obtaining recourse 
for our grievances? 
--Judy Rogers, RN, 
Edmonton, Alherta. 

Realities of motherhood 
I thought that readers of 
your audiovisual page might 
be interested in learning of a 
slide-tape presentation I 
produced last year during the 
International Year of the Child. 
As an occupational 
therapist. I have worked with 
burned and battered babies 
and been saddened to see the 
anger and blame their young 
mothers are subjected to by 
medical and paramedical staff 
in hospitalso It is seldom 
anyone focuses on her as a 
desperate, lonely and 
neglected person. 
I wondered how to 
prevent this situation and, as a 
result, produced a 
photo-essay on the realities of 
motherhood which I have 
titled "Raising kids is hard: 
when you're alone it's harder." 
The slide-tape 
presentation is intended 
primarily for unwed mothers 
who must decide whether or 
not to keep their baby 0 It is 
now being used by Terra, an 
association assisting unwed 
mothers, whose members 
helped me produce the 
slide-tape. The purchase price 
for the package is $80 
(including 100 slides, cassette 
and script); rental fee is $12, 
plus $4 for postage and 
If your group wishes to 
buy a copy but lacks funds, 
might I suggest approaching a 
service club in your 
community such as Rotary or 
For more information, 
write: Mufty Mathewson, 
BPT, OT Reg.. 10322-/32 
Street, Edmonton, Alto., 
T5N lZI. 


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U of A Postscript Program offered by Gran! In all the years I have Winnipeg, and I was the 
I was very pleased to note MacEwan Community been a professional nurse, I psychiatric nurseo 
the summary of university College in Edmonton and have never heard a remark In this position I 
programs for RN's in the Calgary, and the Extended made to this effect by doctors observed and counselled 
January issue, and would just Care Program developed by or other members of the children and parents; taught 
like to add, for the record, that the same college. The latter health team. What in God's nurses and interns - both 
some courses taken at will soon be available to name is wrong with nursing? formally and informally; took 
Athabasca University are nurses on a distance delivery Nurses as a group of social histories: recorded 
transferable to The University method which allows nurses highly trained professionals conferences; gave reports and 
of Alberta's Post-RN who cannot attend lectures are respected and they know home visits, and did much to 
Program 0 nine to five, Monday to it. I do not know of a single change peoples' attitudes 
-Amy E. Zelmer, PhD, Dean, Friday, to participate in patient who has shown more regarding the emotionally ill 
Faculty ofNursingo post-RN education. respect to a particular nurse child and his needso 
I look forward to articles because she graduated from a This was the first attempt 
that will dispel the myth that university generic program. in Canada to have emotionally 
A non-traditional route only universities offer Again, no disrespect has been disturbed children treated in a 
I sincerely hope that the post-RN education. shown to a nurse by a patient hospital setting with a 
person who compiled "Your -Liz Dawson, RN, M.Ed., because she has a diploma psychiatric nurse. We had a 
guide to Post-RN University Program Head, Occupational from a hospital-based or tremendous success story 
Programs in Canada" H e(/Ith Nursing Certificate community college program. which, in retrospect, was the 
(January), did not Program, Grant MacEwan Nurses will be respected highlight of my nursing career. 
intentionally disregard the College, Edmonton, Alta. solely for the kind of care they -Dorothy (Campbell) 
many innovative and valuable give, knowledge they have Mulder, RN, RPN, Part-time 
certificate programs being Editor's note: A complete list and the attitude with which supervisor in Geriatrics, 
offered to nurses by of all the programs offered by they care. BeaconHil/Lodge, Winnipeg, 
community colleges which are community colleges across If nurses are Man. 
flexible and innovative Canada would obl'iously be handmaidens. then this also 
enough to respond to the too vast an undertaking for includes university-prepared 
needs of Canadian nurses who our limited resources. nurses. Logan should explain Kudo from afar 
are becoming more adamant to readers how university I would like to take the 
in demanding post-RN nurses have succeeded in not opportunity to say how much 
educational opportunities Security is... being handmaidens. I enjoy reading The Canadian I 
specific to their specialized Jo Logan's article It may be that Nurse, and that it has proved 
area of nursing. (January 1980) is both professional salvation lies in to be most beneficial to me 
I hope that a similar thought-provoking and university preparation, but, as throughout my nursing 
article in the near future can mind-boggling. She tells we are clamoring for scientific courses. Thank you. 
be done on college-based nurses that they are status, let us use some of that -Tanya Mark, Holder, 
programs, or at least some handmaidens to other knowledge to support our A ustralia 0 
form of recognition for what is members of the health belief. 
being done in other than the inter-disciplinary team- -Mohamed H. Rajaha/ly, I 
traditional university doctors, pharmacists, social RN, EdM, Lecturer, School of Nurses in primary care 
programs (some of which workers, physiotherapists, Health Education, Okanagan There seems to be a I 
haven't changed their content, occupational therapists and College, Kelowna. B.C. rumor at large in the nursing 
faculty, or presentation dieticians - because most of community that McMaster's 
format in twenty years)o them do not have a Educational Program for 
I think that all nurse university-based education. Career highlight Nurses in Primary Care 
educators fully realized that She supports her position Scanning 1979CNJ's,I (Nurse Practitioner Program) 
university-based programs are with a few personal examples. came across the January issue has been discontinued. 
more prestigious and of higher If anecdotes can lead to with an article entitled" A I am pleased to deny the 
status than their "poor generalization. then I can New Role for the Psychiatric rumor and to confirm that the 
country" cousins, the safely state that nurses are far Nurse" by Kathy Hegadoren Ontario Ministry of Colleges 
colleges. I urge you to give from being handmaidens. I of Edmonton. Ms. Hegadoren and Universities, with the 
equal space to some of the myself have witnessed nurses states that the admittance of support of the Ministry of 
newly developing programs telling other health emotionally disturbed Health, has agreed to continue 
such as the Co-operative professionals where to "get children to a general ward is supporting the program for at 
College Program For off' or "go and fly a kite" 0 an "experiment" and a "new least another year. 
Occupational Health Nurses If our insecurity is so role for the psychiatric The program continues to 
in the metro-Toronto areao intense and we keep telling nurse" 0 receive strong support from 
Yes, even we in the West are ourselves that our salvation as For your readers,l wish the Faculty of Health 
involved in some new a profession lies in a to state that in 1951-54, an Sciences, McMaster 
off-campus delivery programs university degree, it will not almost identical project was U ni versity. 
such as the Occupational be long before this insane. instigated by child psychiatrist -Mona Callin. Director, 
Health Nursing Certificate poorly documented notion Dr. Gordon Stephens, M.D., Educational Programfor 
becomes reality. at the Children's Hospital. Nurses in Primary Care. 

B lIIar"h 11180 



Prevention pays, the Healthiest Babies Possible more about what consumers be. The court has overruled an 
PHN teUs committee Program (see CNJ October really want and expect from Ontario College of Nurses 
1979) which has been running their health care system. finding that the director of 
in Vancouver and as an nursing at an Ottawa Hospital 
In December 1979, a experiment in Torontoo CNF announces performed incompetently in 
nurse-consultant in southern "That's the kind of program directing RNA 's to carry out 
Ontario resigned from a that's needed," she said, and special scholarship certain functions previously 
committee set up to study she remarked that preventive reserved for registered nurses. 
ways to lower the death rate programs with the emphasis The Canadian Nurses At stake is the key issue 
of premature and newborn on education reflected "a Foundation has announced of whether a member of the 
babies. Her reason for different attitude toward that it will name a nursing management team (such as a 
quitting? The Medical Officer health careo "In Ontario the scholarship in memory of director of nursing) is subject 
of Health in Toronto, where Foundation for the Mentally Virginia A. Lindabury, editor to discipline by the 
she was working, had refused Retarded recently sponsored of The Canadian Nurse from disciplinary body of that 
to show her dissenting report an advertising campaign 1965 to 1975. who died last profession while acting in an 
to the provincial committee of focusing on the effects of September. administrative capacity and 
which she was a member. pregnant women's habits on "Throughout her years carrying out the duties 
Doreen Hamilton, a nurse unborn children, and she said with the magazine. she attendant on the 
with degrees in sociology and the success of this campaign supported the foundation's administrative function of that 
education and varied should serve as a lesson to purposes and goals in aid of position. 
experience in community professionals involved in nursing scholarship and 
health projects, had written a public healtho "We've tried helped make the work ofthe Singer Della Reese will 
"minority" report for the selling beer on television and foundation known to nurses perform a benefit concert in 
committee showing that an we know that works, why not throughout Canada," Louise London. Ontario, this Spring 
education program for new sell health too?" Tod, CNF president said in to raise funds for a new 
mothers and teenage women The controversy wi1l not announcing the scholarship. neuro-treatment microscope 
would be effective in the city's be resolved until after The Registered Nurses for University Hospital in that 
goal of reducing the number of Hamilton and the new task Association of British city. Reese is recovering from 
high risk pregnancies. The force submit their report to Columbia has supported the neurosurgery performed at 
majority report submitted by the Toronto Board of Health foundation's move with a University Hospital after she 
the provincial committee, the at the end of April this year, $10,000 donation in memory collapsed during a taping of 
University Teaching but clearly the report will of Virginia ; individual nurses Johnny Carson's "Tonight" 
Hospitals Association and the recommend preventive across Canada have also show. 
Hospital Council of programs which wj)J limit the expressed the wish to donate 
Metropolitan Tor
nto (UTHA number of high risk births to a memorial fund in her A Bonus from RNABC 
HCMf) had recommended rather than estimate and plan honor. 
instead a central for a large number of high risk CNF is the only Canadian The RN ABC has announced 
computer-based patient infants to be born in the city 0 foundation that deals that funding is available to 
information registry and had Asked for her views on exclusively with support to RNABC members to develop 
also advocated improving nurses becoming more nursing scholars. Since its post-basic clinical nursing 
neonatal intensive care politically active and getting inception in 1962,216 nurses courses, or to study the need 
facilities in Toronto. The cost involved in the actual decision have benefited from more for such courses. To meet the 
of the proposed program was making in health care policies, than $673.000 in funding. association's requirements, a 
estimated at $6 million a year; Hamilton pointed out that Moneys now come mainly post-basic course must 
comprehensive education this, while desirable, was from personal donations and prepare nurses to function in 
programs would cost about $1 difficult: "It's probably easier bequests from individual clinical specialties which 
million. to do as a private person nurses and from provincial require expertise beyond the 
Hamilton stated at the ratherthan as a nurse," she nurses associationso basic level. 
time that she felt the emphasis said. "As a nurse you're Tax deductible donations At the time of writing, 
on high technology was an always workingfor somebody should be sent to the CNF, 50 RNABC has provided funds 
enormous waste of money and and you're not really free to The Driveway, Ottawa, for the development of three 
she favored the introduction say what you feel. For Ontario, K2P IE2. programs: in Occupational 
of preventive programs. Also instance, I know that a large Health Nursing, Pediatric 
included in her plan were number of obstetrical nurses Nursing and Obstetrical 
subsidized prenatal classe
, in this city are not comfortable Health happenings Nursing. The association has 
genetic counseling studies of with current obstetrical Who decides the duties of a budgeted $100,000 for the 
out-of-hospital birthing practices in the hospitals but nurse working in an total program, and up to $5000 
centers and the legalization of they reall y ha ve no choice. .. institutional setting? is available for each course. 
midwiveso The Task Force for the An Ontario Divisional Court For more information. 
Recently, CNJ spoke Prevention of High Risk has ruled that it is hospital contact Ruth Burstahler, 
with Hamilton, who has since Pregnancies plans a series of management, rather than the Continuing Education 
been rehired as a member of citizens' meetings in the City College of Nurses, the Consultant, RNABC, 2130 W. 
the Task Force for the of Toronto this spring, and the licencing body in that 12th Ave., Vancouver, B.c., 
Prevention of High Risk health care professionals province, that has the right to V6K 2N3. 
Pregnancies. She referred to I involved hope to find out decide what these duties shall 

Tk_ t"'.....,....... ....Jr.. 

.....rA 1 QRO A 

Some people need 
to be cared for. Others 
need a chance to care. 
Upjohn HealthCare Services 
brings them together. 


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Two-way closed circuit TV - the next best thing to being there? A 
first for nursing is the course in advanced analysis of trends, issues and 
problems in nursing that Dr. Shirley Stinson of the University of Alberta is 
teaching simultaneously to two groups of students - one in Edmonton, 
the other 185 miles away at the University of Calgary. 
There are 5 M.N. (Master's in Nursing) students in the Edmonton 
group and 6 graduate students (nurses taking a variety of master's 
degrees) in the Calgary group. 
Each viewer group can see what tS being transmitted from their 
studio, via two TV screens; through two additional screens they can see 
the other group via a "split screen", plus obtain close-ups on a second 
screen. Even visual aids as small as the title of a book and 
"blackboard-type" writing on the flipchart are readable on the close-up 
Simultaneous visual and audio transmission between Edmonton 
and Calgary is via microwave. A direct phone line is also available in the 
TV studios and all transmission is as confidential as a phone call. 


Occupational health 
nurses receive 
The Ontario Occupational 
Health Nurses Association is 
$95,000 richer after receiving 
a grant from the Ministry of 
Labor for the development of 
a certification program for 
occupational health nurses in 
that province 0 
The award, out of the 
Ministry's Provincial Lottery 
Funds for ManpowerTraining 
and Development, will be 
used to develop the various 
program components. Target 
date for implementation will 
be January, 1982. 
"Occupational health 
nurses have, through their 
initiative and commitment, 
been granted both an 
opportunity and a challenge; 
they can bejustifiably proud 
of this expression of 
confidenceo" OOHNA 
president Madeleine 
Wenman. commented, "This 

is a tangible recognition of 
their efforts to expand theIr 
contribution toward the goal 
of reducing the incidence of 
injuries and illnesses in the 
workplace 0 .. 

solicit members 

The Western Nurse Midwives 
Association has announced 
their executive for 1980: 
president is Peggy Anne Field 
of Edmonton, president-elect 
is Carolyn Fumalle of 
Victoria. B.c., and the 
secretary-treasurer is 
Margaret McKenzie of 
The association is 
actively canvassing for new 
members this year, and invites 
inquiries to be sent to the 
Association at P.O. Box 4268, 
Edmonton, Alberta, T6E 4T3. 
The membership committee 
chairman is Judy Friend of 
Edmonton. iI 

111 liI



The Conrectionel) Manufacturers 
Association or Canada is 
sponsoring a one-day invitational 
seminar on nutrition, including 
such topics as the role of nutrition 
in competitive sports, new 
perspectives on nutrition and 
health disorders, the psychology 
of eating and the snacking 
syndrome. To be held March 10 at 
the Four Seasons Hotel in 
Toronto. Contact: Jane Hope, 
Suite /01,1185 Eglinton Ave. E., 
Don Mills. Ontario. M3C 3C6. 

Continuing Nursing Education 
focusing on Nursing and 
Geriatrics, a seminar, will be held 
March 26 at McMaster 
University. Contact: Patricia 
Carter. Program Assistant. 
Program in Continuing Medica[ 
Education. Room I M6, 
McMaster Uni\'ersity. Hea[th 
Sciences Center. Hami[ton, 
Ontario. LBS 4J9. 

The Shifting Medical Paradigm: 
From Disease Prevention to Health 
Promotion, a conference for 
health professionals, planners and 
consumer advocates, will be held 
March 20-21. Contact: Lifesty[es 
Programs. Centre for Continuing 
Education, 5997JonaDrive, The 
Uni\'ersity of British Columbia 
Campus. Vancou\'er,B.Co, 
V6T 2A4. 

The Faculty or Nursing and 
Extension of the University of 
Albena is offering the following 
courses: Teacher Effectiveness in 
Nursing, Feb. 28-29; Nursing 
Aspects of Intravenous Therapy, 
March 26 or May 5; Management 
oflnflammatory Bowel Disease, 
April TBA; Advanced Obstetrics, 
April 21-25; Nursing Management 
of Pain, May 16; Introduction to 
E.C.Go Interpretation, June TBA. 
Contact: Marg Steed. Director. 
Continuing Nursing Education. 
F acuity of Extension. The 
University of A [berta , Corbett 
Hall. Edmonton. Alberta, 
T&:; 2G4. 

Respiratory Rehabilitation in the 
Eighties is a seminar sponsored by 
the York-Toronto Lung 
Association on April 2 at the 
Royal York Hotel. Pre-register by 
March 3. Contact: Nancy 
B[ackburn, York-Toronto Lung 
Association, [57 Willowda[e Ave., 
Willowda[e. Ontario, M2N 4Y7. 
Clinical Electrocardiology with 
Leo Schamroth. MD., a 
workshop for general 
practitioners and critical care 
nurses will be held on April 10-11. 
Dartmouth Inn, Dartmouth, N .S.; 
April 14-15. Park Plaza Hotel, 
Toronto, Ontario; and April 
21-22, Four Seasons Hotel, 
Vancouver, B.C. Contact: 
Conference & Seminar Services, 
Humber College. P.o. Box [900, 
Rexdale, Ontario. M9W 5L7. 
The North West Territories 
Registered Nurses Association will 
hold its third biennial meeting 
April 16-18 in Yellowknife. The 
theme will be "Legal Aspects of 
Nursing" . Contact: Rusty 
Stewart, Secretary, NWfRNA. 
Box 2757, Yellowknife. N.W.T., 

Canadian Nurses Association 
annual meeting 
and convention 


I}C @
 .....-'S ^ 


's 'to 

The Head Injured Patient, a 
workshop presented by the 
Canadian Association of 
Neurological and Neurosurgical 
Nurses - Manitoba Chapter, will 
be held April 15-16. Contact: The 
Manitoba A ssociation of 
Registered Nurses, 647 Broadway 
A\'e., Winnipeg, Manitoba. 
R3C OX2. 

An Extended Care Nursing 
Certificate Program designed to 
prepare registered nurses to 
provide quality care to the aged, 
disabled and chronically ill, will 
be available by spring, 1980. 
Nurses may complete modules at 
home by means of individualized 
study packages. If you are 
interested in the program contact: 
June Golberg. Acting Program 
Head. Extended Care Nursing 
Certificate Program. Grant 
MacEwan Community College. 
Box 1796. Edmonton, Alberta, '" 

The CNA Audited Financial Statements, which 
normally appear in the March issue of this journal, have 
been dropped from the 1980 publication as an economy 
measure. The statements will, as usual, be included in the 
association's annual meeting and convention report 
available to registrants at CNA's annual meeting in 
Vancouver, June 22 to 25. In addition, members wishing 
to receive a copy of the statements may write to CNA, 50 
The Driveway, Ottawa, Ontario, K2P 1 E2. 


Late news flash 

Israeli Nursing Leader 
To Deliver Kellogg Lecture 

Dr. Lea Zwanger, head ofthe 
Division of Allied Health 
Professions in the Ministry of 
Health, Tel Aviv, Israel. has 
agreed to deliver The Kellogg 
Lectureship scheduled for the 
opening day of this year's CNA 
Dr. Zwanger's address will 
focus on the nurse's role in 
delivering primary care, a role that 
may be seen as a solution to one 
of society's current and emerging 
problems in the area of health and 
the spiralling costs of health care 
in Canada. 
In accepting the invitation, Dr. 
Zwanger said: "Primary Health 
Care - Nursing, is one of my major 
educational and service interests. 
The statements you provided 
about CNA's beliefs fit my own 
convictions. Therefore, I hope that 
my presentation will reinforce 
those of CNA. " 
Dr. Zwanger who was born in 
Jerusalem received her Diploma, 
Graduate Nurse from 
Henrietta-Szold Hadassah School 
of Nursing. She earned her B.Sc., 
MA and EdD from Columbia 
University, Teacher's College in 
New York City. 

The Cenlldlen "ur.. 


. Kellogg Lectureship: 
"Primary care--nursing" 
. Wine and cheese reception 
Your host: RNABC 

· Keynote address: "Who 
shapes nursing in the 80's?" 
Lorine Besel. Royal Victoria 
Hospital, Montreal. 
. Panel presentation: 
"Financing health care" 
. Meet your candidates 

. Panel discussion: "Labor 
movement vis à vis the 
professional association" 
. Dinner and entertainment 

. Debate: "Continuing 
education: should it be voluntary 
or mandatory?" 






Guest speaker Dave Broadfoot 
- Member for Kickinghorse Pass 
Renfrew the Mountie, Member of 
the Royal Canadian Air Farce and 
Canada's Ambassador of 

Ii1m:h..1IIIIIl 11 

ntr I ducing New 
they stay twice 


Why It's Better 
for Baby 

4 J f,ø 

I Softer surface next to 
. baby's skin 
o Embossed topsheet looks 
and feels softer_ . reduces 
skin contact and increases 
separatIon of skin from 
moisture in pad 

#if" 0 



Z A drier, more 
. comfortable baby 
o Polyester hbre topsheet is 
more hydrophobic.. _ does 
not absorb flUIds itself but 
encourages passage 
through into absorbent 
padding below. _ resists 
o Stronger absorbent pad 
with stronger tissue enve- 
lope... provides 225 percent 
more wet strength for a 
60 percent reduction in 
tearmg and shredding. 

Proof Positive That Quilted Pampers 
Stay Twice as Dryas Cloth 


. \ 


Goth Pampers 

Equal amounts of 
water are placed on 
each chaper 

A blotter IS placed 
over each wetted 

A weight is placed on 
each blotter 

Qulted Pampers IS 
tWIce as dry as cJoth 

I uilled · am 
as dryas clol 


..... - 
... -....


'J.J' I 










Pampers - 
used more often than cloth 
in hospital nurseries 

Fur furth! _I wnt
h - - 


x. -. 

It's Better 
for Nurse 
and Better 
for Mother 

, Saves time and 
The supenor contain- 
ment of New QuIlted 
Pampers versus cloth 
benehts both nurses and 
mothers wIth: 
o Fewer changes of 
bed Imen and 
baby's clothing. 
o More time for 
other important 
tasks for nurses, 
more playtime 
with baby for 

Easier than cloth to 
fit and change 
A one-piece system- 
more convement than 
cloth to change and clean 
up-easy to fit with tape 
not pms. 

'" -" ." '" 

\,;, Îi'.'lÌh 



f . 




Consent, sterilization and mental 
incompetence: the case of "Eve" 

Fearing that her 24-year-old, 
physically mature, potentially 
sexually active, mentally retarded 
daughter, "Eve", might become 
pregnant, Mrs. E. applied to the 
Court for authorization of consent to 
the performance of a tubal ligation on 
her daughter. Her application was 
denied 1 but the reasons for the denial 
are at least as important as the 
outcome since the decision champions 
the interests of the individual unable 
to make the decision himself to 
undergo such a procedure. The 
observations ofthe P .E.1. Supreme 
Court (Family Division) judge who 
heard the case. Mr. Justice C. R. 
McQuaid. are noteworthy for their 
sensitive and careful examination of 
the issues, rights and concerns of both 
mother and daughter. 

- The area of sexual activity is of major 
concern to those responsible for the care 
and well-being of the mentally retarded. 
Unfortunately, the topic generally 
becomes charged with an overlay of 
individual emotional responses: similar 
responses may be precipitated when 
teenage sexual activity is under 
discussion. 2 Although there is 
considerable mythology and 
misinformation about the sexuality and 
fertility of the mentally retarded and the 
potential transmission of genetic defects 
to their offspring, there is in fact the 
practical problem of what. if any, \. 
- contraceptive measures can be provitñ:d 
for such a sexually active individuaI.
many cases, traditional methods of ' 
contraception (oral contraceptives, 
LU.D., foams and creams, etc.) are only 
as effective as the user's adherence to 
the method selected. Sometimes, 
complete supelVision of the individual is 
necessary to ensure that the method 
selected is effective. Because the usual. 
contraceptive methods may be 
ineffective for retardates, sterilization 
may be viewed as the major viable ' 
alternative. Such an approach is indeed 
not surprising in a society where 
vasectomies and tubal ligations are 
frequently sought by competent 
Canadian adults in consultation with 
their physicians. 

Note, however, the use of the key 
word "sought": the individual seeks and 
consents to the performance of this 
surgical procedure upon his or her body. 
In the case of" Eve" and others like her, 
this ability to give such consent may be 
lacking. Can others give consent to such 
a procedure on this person's behalf? 
How do we balance the interests and 
rights of this individual against those of 
society or against the concerns of the 
individual's family? 
* It is a cardinal principle of the law 
that the adult individual has the right to 
control his body from invasion and 
interference by others: failure to respect 
this individual right may result in the 
commission of the legal wrong of 
battery .Ifthe individual consents to 
interference with his body, then the tort 
(or wrong) of battery is not committed. 
Similarly, if there is legal justification for 
the touching (such as in a health- or 
life-threatening emergency), then no 
wrong is committed. Thus for those 
delivering health care, consent or other' 
legal justification are necessary I 
prerequisites to commencing treatment. 
This consent may be expressly given or it 
may be implied but always, in order for it 
to be legally valid, the following 
requisites must be present: 3 
. The consent must be voluntary, 
freely given and must be obtained 
without misrepresentation or fraud. 
. The act performed must be 
relatively consistent with the act for 
which the consent was obtained. 
. The act for which the consent is 
obtained must not in itself be an illegal 
. The consent must be informed: the 
patient must be given sufficient 
information regarding the nature and 
consequences of the proposed treatment 
to permit the patient to come to a 
reasoned decision whether to accept or 
reject the treatment. 
. Finally, to give consent the patient 
must have the legal capacity to do so 
(capacity referring to both age and 
mental competence) 0 
Traditionally, it is the mentally 
competent adult who may give consent 
to treatment. Adulthood is attained at 
age 21 (common law age) or at the age of 
majority (18 or 19 depending on the 
specific provincial legislation 
applicable). In the area of medical 
treatment, some provinces have enacted 

legislation which further lowers the age 
of consent, thereby enabling minors 
(those under 18 or 19) to give consent to 
medical treatment. Thus, for example, in 
British Columbia and New Brunswick, 
under certain conditions, a minor of 16 
may give consent to medical treatment. 4 
I t is the second aspect of the 
prerequisite of capacity that is of 
concern here: mental competence. the 
law requires that an individual must have 
I the ability to understand the nature and 
effect of the treatment being proposed. If 
this ability is lacking either by reason of 
age, immaturity or illness or other mental 
disability, then those providing health 
care must look to others for such 
consent. At common law, the persons 
having authority to give such consent are 
a parent, guardian or the Supreme Court. 
The law imposes another safeguard to 
protect the person who is unable to give 
consent on his own behalf: the procedure 
in question must be therapeutic, that is, 
for the benefit of the incompetent 
The person wishing to provide 
consent for the incompetent individual 
must attempt to place himself in the 
position of that person and arrive at the 
decision that person would have made if 
able to do so. While almost impossible to 
do with any high degree of certainty, 
nevertheless, this imposes upon the 
substitute decision-maker the 
responsibility of acting in the best 
interests of the incompetent person. In 
the case of "Eve" ,the parent asked the 
Court to authorize her consent to her 
daughter's sterilization as a 
contraceptive measure. The Court 
followed the trend of judicial 
determination and examined the 
proposed procedure in the light of its 
inherent benefit to the individual" Eve" . 
Since there is no specific legislative 
authority permitting such sterilization, it 
was held that sterilization of a mentally 
incompetent person solely for the 
purpose of contraception is not a 
therapeutic procedure justifying the 
Court's authorization of the consent of 
anotherto its performance. 

The case of "Eve" 
Eve (a pseudonym designated by the 
Court) is moderately retarded. The Court 
was told that she is an individual "having 
some limited learning skills". 
She suffers from extreme expressive 
aphasia, making her unable to 


communicate to others any thoughts or 
concepts she might perceive inwardly. 
No one knows, therefore, whether Eve 
has inwardly perceived a thought or 
concept, nor her degree of understanding 
of this idea or concept. The retardation 
further compounds this difficulty. 
Eve attends a school for retarded 
adults during the week and lives at home 
with her mother on weekends. Her 
mother, Mrso E., is a widow, nearing 60 
years of age. At school, Eve developed a 
close relationship with another student, a 
young man. On being infonned of this 
situation, Mrs. E. became concerned 
that Eve could become pregnant and that 
she would therefore have the 
responsibility of any child born to her 
daughter. At Mrs. E.'s age, and in her 
circumstances, such a responsibility 
would present overwhelming difficulty. 
Thus, Mrs. E. instituted this application 
to the Court. In considering these facts 
the Court was sympathetic to the bona 
fide concerns of this mother for the 
well-being of her daughter and the 
potentially harmful emotional effects of a 
pregnancy and subsequent birth upon 
Eve. Eve would have no concept of 
either the idea of marriage or of the cause 
and effect relationship between sexual 
activity, pregnancy and birth. While Eve 
might be able to care for a child under 
close supervision, she would have no 
concept of motherhood other than in a 
mechanical sense. 
Before considering the legal 
principles involved. Mr. Justice 
McQuaid examined specific evidence 
and concluded that Eve was incapable of 
providing infonned consent and would 
be unable to undertake effective 
alternate means of birth control. It was 
also established that the psychological 
effect upon Eve of such a procedure 
would probably be minimal. 
The decision reviewed the basic 
legal principles regarding consent to 
medical treatment, the judge indicating 
the "gray area" surrounding the 
question of consent on behalf of a 
mentally incompetent individual. While 
valid substitute consent could be given 
for a strictly therapeutic procedure on 
behalf of the retardate (e.g. consent tOFß. 
an appendectomy), the nature of this \'- 
proposed treatment demanded stringent 
His Lordship quoted from the case 
of Murray Vo McMurchy; 5 (In that case, 
while delivering a young woman by 
Cesarean section, the physician 
observed fibroid tumors in the patient's 
uterus and proceeded to tie off her 
Fallopian tubes. Because there was no 
evidence of emergency in the situation, 
the Court held that such a drastic 
procedure should not have been 
undertaken without prior discussion with 
and the consent of the patient. The 
doctor was found liable for exceeding the 
patient's consent.) 

"We get tremendous satisfaction 
from doing our jobs well. 
It's more than worth the effort 
. " 
we put ffi. 
b ) 

r'\ '\. 
\ 1 
-.; . 
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. 'f 

S uzanne and Larry knew that working as a flight atten- 
dant meant taking on a lot of responsibility and hard 
work. But they were confident they could meet the 
challenges. And they were right. 
What got them their jobs was not simply the fact that 
they met our basic criteria. Suzanne and Larry displayed 
the important "extras" we look for in candidates. They are 
both self-starters with outgoing personalities and a real 
desire to provide a high standard of customer service. 
It's people like them who make us one of the world's 
leading airlineso And the rewards of the job-in every 
I sense-make them proud to work with us. 
If you think a career as flight attendant offers the kind 
of challenge and job satisfaction you're looking for, take 
a close look at the minimum requirements listed below. 
Then, only if you meet them all, write to: Air Canada, Cabin 
Personnel Employment Office, PO. Box 11,000, Dorval 
Airport, Dorval, PQ. H4Y 1 B6. 
In return we'll send you our brochure, together with 
a detailed application form that lets you tell us what you 
have to offer. 
· Canadian citizen or landed immigrant 
· High school graduate or equivalent 
· Minimum one year permanent work experience, or one 
year post-secondary education in lieu thereof 
· Willing and able to relocate 
· High standard of appearance; excellent health and 
· Unaided vision should not be below 6/15 (20/50) in each 
eye. Glasses not permitted. Contact lenses are accept- 
able provided visual acuity is not weaker than 6/30 
(20/100) uncorrected in each eyeo You may wish to 
check with your eye care specialist 
· 158.7 cm (5'2")-186.8 cm (6'1") height (without shoes), 
with weight in proportion 
· Must be able to interact and work effectively with people, 
sometimes under difficult and stressful circumstances. 


"It must be remembered that the effect 
of the procedure here was to deprive the 
plaintiff of the possible fulfillment of one 
of the greatest powers and privileges of 
herlife. .. 

His Lordship stressed the scrupulous 
caution that must be taken before 
similarly depriving Eve even though she 
might not be able to understand and fully 
appreciate that fulfillment and privilege." 
On consideration of the legality in 
general of sterilization for contraceptive 
purposes, His Lordship concluded that 
such sterilization is not illegal if the 
patient voluntarily agrees to the 

procedure, ifthe consent is informed and 
if there is found a benefit to the patient 
having regard to either the patient's 
health or to other justifiable reasons, ego 
socio-economic factors. 7 While such 
surgery may be necessary to preserve or 
protect life or health, it may also be 
legally undertaken to preserve the 
quality oflife of the patient. This was the 
result in C ataford V. Moreau, 6 a case in 
which the plaintiff sued when the tubal 
ligation perfonned after the birth of her 
tenth child was faulty and she 
subsequently delivered an eleventh 
child. However, Mr. Justice McQuaid 
cautioned that purely contraceptive 

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Reg'd T M 


sterilization, even with consent, may not 
necessarily be legal in all situations. As 
always, the facts of each case are 
The pennanence of this 
non-therapeutic procedure was the major 
concern of His Lordship. He considered 
the English case ofRe D (a Minor). D 
was a retarded child suffering from Sotos 
Syndrome. Her parents had decided to 
have her sterilized at age 18 to prevent 
her having children who might also be so 
afflicted. Their family physician 
concurred in their views. When D 
reached puberty at age 10, the family 
sought to have her sterilized at once. The 
Court denied the application, stating that 
sterilization involves the deprivation of a 
woman's basic human right, the right to 
reproduce, and performance of such a 
procedure for non-therapeutic reasons 
without her consent would constitute a 
violation of that right. In that case, the 
evidence was that while 0 presently was 
unable to appreciate the nature and 
consequences of this procedure because 
of her age (11 years), there was a strong 
likelihood that she would be able to 
understand its implications when she 
reached 18. The Court refused to deny 
her the opportunity and right to make 
this choice on her own behalf in later 
years 0 The Court further stated that any 
decision to undergo surgical sterilization 
for non-therapeutic purposes was not 
solely within the clinical judgment of a 
physician.>> Here Mr. Justice McQuaid 
found that the test of the therapeutic 
benefit of such a procedure is neither the 
subjective view of parents nor the 
clinical judgment of a physiciano An 
objective position with regard to benefit 
must be taken. 
In the case of Eve , the request for 
court authorization of the consent 
invoked the traditional jurisdiction of the 
Court as parens patriae, that protective 
responsibility toward the Queen's 
subjects (i.e. the State) which is 
delegated to the Courts by the State. 
This protection is given to those who are 
unable to take care of themselves and is 
exercised where injury has occurred or 
where there exists a likelihood of hann 
occurring. His Lordship quoted from the 
wo",s of Lord Eldon in 1827: 

.. ...and it has always been the principle 
of this Court not to risk the incurring of 
damage to children which it cannot 
repair, but rarher to pret'ent the damage 
from being done... "10 

Because of the irreversible nature of 
sterilization, the denial to Eve of her 
fundamental human rights, and the 
possibility offuture medical remedy for 
Eve, His Lordship concluded that the 
Court did not have the authority or 
jurisdiction to authorize a surgical 
procedure such as sterilization for purely 
(Continued on page 52) 



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Texts they'll learn from no

Dorothy A. Mereness 
Cecelia Monat Taylor 

7th Edition 
Bv Mary Topalis. RN.. Ed.n 
and Donna Conant Aguilera. 
RN.. Ph.D.. FAA.N. 
Now in an extensively 
revised and updated edition. 
this comprehensive text reflects 
the growing emphasis on 
commumty mental healtt> and 
explores the nurse's expanded 
role. Two new chapters 
consider modern psycho- 
therapeutic technlques/ 
applications and patients with 
antisocial behavior patterns. 
Students will also find new 
material on crisis intervention. 
community psychlatryo and 
suicidal behavior. along with 16 
helpfuJ case studies. 
1978.460 pages. 4 illustra- 
tions. Price. 816.75. 

Essentials of 


10th Edition 


By Dorothy A Mereness. 
RN.. Ed.D. and Cecelia Monat 
Taylor. R.N.. MA 
Updated. revised and 
reorganized. this comprehen- 
sive text emphasizes the 
community health movement 
- and discusses the nurse's 
expanded role In various 
mental health settings and 
Interpersonally based treat- 
ment modalities. It Includes 
timely Information on crisis 
therapy. Intervention. and 
psychosomatic Illness. Two 
revised chapters help students 
better understand the psycho- 
dynamics of observed behavior. 
Several case studies are also 
new to this 10th edition. 
traUons. PrIce. 820.50. 



A New Book! 

By Gall Wiscarz Stuart. RN.. 
M.S.. C.S. and SandraJ. 
Sundeen. R.N., M.S.: with 15 
contrlbu tors. 
Using a nursing-oriented 
conceptual approach to 
psychiatric nursing. this text 
describes man's adaptation to 
illness. and identifies nursing 
diagnoses and specific nursing 
Interventions. Part I Is 
organized according to specific 
nursing diagnoses - anxiety. 
disruptions In the communi- 
cation process. grief. etc. 
Various therapeutic modalities 
presently In use are the focus In 
Part II. These topics reflect the 
comparatively Independent and 
expanded role oftoday's 
psychiatric nurse. The authors 
stress nursing Interventions 
and application of the nursing 
process throughout. Selected 
bibliographies and the latest 
research findings assist 
students with further study. 
April, 1979.656 pages, 24 
illustrations. Price. 820.50. 

11 M.l"'h 1GAn 



. and refer to later. 

A New Book! 
A Sociocultural 
Framework. Volume n 
Edited by Adina M. Reinhardt. 
Ph.D. and Mildred D. Quinn. R.N.. 
M.S.: with 27 contributors. 
The original articles 
A New Book! presented in this new volume 
COMMUNITY reflect the growing Importance 
MENTAL HEALTH of the community health nurse 
NURS IN G " " and offer valuable Insights into 
wide ranging areas of the field. 
An Ecological Perspective The contributors are all active 
By Jeanette Lancaster. R.N.. practitioners and educators- 
Ph.D. and the articles focus on 
This new book uses a unique current opportunities. cultural 
ecologicallv- oriented approach Influences affecting care at the 
to describé various Interventions community level. services 
with populations and clients. specific to todav's society. and 
Discussions cover high risk the future of community 
populations plus Innovative nursing. 
treatment modalities. April. 1980. Approx. 272 
January. 1980. Approx. 320 pages. I 3lUustrations. About 
pages.31IUustrations.About $12.75. 
$ 13.25. 






3rd Edition 
Theory and 
By Donna C. Aguilera R.N.. 
Ph.D.. FAA.N. and Janice M. 
Messick. R.N.. M.5.. F AAN. 
This widely used text 
thoroughly describes the 
evolution of crisis Intervention 
methodology and uses; explores 
differences in psychothera- 
peutic techniques: and prov1des 
an overview of therapeutic 
groups. The authors also 
discuss sociological factors 
ad\'ersely influencing the 
psychotherapeutic process: the 
problem solv1ng process: 
stressful events precipitating 
crisis; and changes during 
1978.206 pages. 161llus- 
tratlons. Price. 812.00. 

A Model for 
Intervention in the 
By Frances Power Rowan. 
R.N.. M.S. 
Your students can deal more 
effectively with chronic 
psychiatric clients In the 
community with this prag- 
matic text! Organized around 
the nursing process. It features 
actual case studies to present 
usable guidelines for devel- 
oping and Implementing new 
coping behav1ors. For each. the 
author includes complete 
Infonnatlon on assessment. 
diagnosis. intervention and 
evaluation. Particularly Inter- 
esting chapters prov1de an 
oveniew of the nursing process 
. . . outline a rationale for 
Intervention and approaches to 
client care.. and show "how 
to" evaluate results. 
C.V. MOSBY COMPANY. LTO. January. 1980.232 pages. 
86 NORTHLINE ROAO About 811.50. 
M48 3E5 

health care 
and the 
nursing process 

Margot Joan Flamer 


By Margot Joan Fromer. 
B.S.. MA. M.Ed.: with 7 
Help your students stay 
Informed of the exciting new 
changes In community health 
nursing wilh this comprehen- 
sive text. Its timely discussions 
prov1de a holistic v1ew of 
human development by 
stressing three basic concepts: 
the health-Illness continuum: 
humankind as an open system 
that always relates to and 
interacts with Its env1ronment; 
and the effects of various 
situations. health problems 
and stressors on the health and 
development of the indlv1dual. 
family and community. 
1979. 484 pages. 110 
illustrations. Price. 819.25. 

A New Book! 


Current practice in 
community nursin



Practice and 
I'mpediwa in 
Nuniag Seriee 




Because practical information never loses its usefulness. 

Tha C"an........ "IIP_. 

A capsule history of your journal 

"The need to communicate has been the motivatingforce behind the development of newspapers, magazines and 
journals of all types . Depending on the nature of the information to be communicated, the publication may become 
specialized and develop specific aims but the simple hunger of the people to know what others with similar interests 
are doing is always the underlying ifunspoken raison d'etre." 
Margaret E. Kerr, editor The Canadian Nurse 

1905 - The first, 32-page issue of The Canadian Nurse 
appears, largely at the instigation of Mary Agnes Snively, 
Toronto General Hospital superintendent of nurses. Sponsored 
by the TGH alumnae, the operation is in the hands of a business 
firm, Commercial Press. A member of the medical profession, 
Dr. Helen McMurchy, is chosen to act as editor on a part -time 
basis, a move calculated to deflect criticism being voiced by 
doctors who were "at a loss to understand this show of 
independent thinking". Journal policy is governed by an 
editorial board composed entirely of nurses and a registered 
nurse, M. Christie, is named business manager. 

1907-TheCanadianNurse goes monthly. 

1910-ln May, Bella Crosby, a graduate nurse. is appointed 
associate editor part -time ofT he Canadian Nurse. Crosby 

begins to meet with nurses throughout Ontario and in Montreal 
to stress the national character of the journal and solicit 
support . 
1916 - The Canadian Nurse is purchased by the Canadian 
National Association of Trained Nurses (later to become the 
Canadian Nurses Association). The editor of the journal is 
Helen Randall, a graduate of the Royal Victoria Hospital in 
Montreal. Subscribers now number 1,800. 

1924-Randall resigns, with the subscription list at 1,950. 
Jean S. Wilson becomes executive director ofCNA and editor 
of The Canadian Nurse. 

1932 -CNA headquarters moves to Montreal from 

The Canadian Nurse 


VOL. 1. 


No. 1 

THE CANADIAN NURSE will be devoted 
to the interests of the nursing profession 
in Canada. It is the hope of its founders 
that this magazine may aid in uniting and 
uplifting the profession and in keeping 
alive that esprit de corps and desire to 
grow better and wiser in work and life 
which should always remain to us a daily 
For the protection of the public and 
for the improvement of the profession 
THE CANADIAN NURSE will advocate 
legislation to enable properly qualified 
nurses to be registered by law. 




VOI.1, No.1, The Canadian Nurse, 
March, 1905. 


Mary Agnes Snively 
Lady superintendent. Toronto General Hospital 

20 ".rch 1lIIIO 


1933 - Ethel Johns of the Winnipeg General Hospital is 
appointed editor and business manager of The Canadian Nurse, 
the first full-time appointment to this position. Johns' concern is 
with ways to increase subscriptions. She makes changes in the 
format of the journal and improvements in advertising 

1944 - Johns retires; the mailing list stands al 5.000 
subscribers. Margaret E. Kerr becomes editor, a position she 
will hold for 21 years. 
1946 - At least one article and all releases from the National 
Office, are to be in the French language for every issue of the 

1949 - Kerr begins her campaign for subscription through 
association fees. 

1950 - NBARN becomes the first provincial association to 
accept a plan to include journal subscriptions in the annual 
registration or licensing fee paid by members. Other provinces 
follow New Brunswick's lead. 

1955 - Journal staff is increased to include its first full-time 
assistant editor, a circulation manager and advertising manager. 

1958 - Kerr's title is changed to e"ecutive director and 
editor of the journal. Editorial advisors are appointed, with each 
province appointing one member (two from Quebec) 0 
1959 -In June, the first issue of L'injìrmière canadienne is 
published. The mailing list stands at: 
English: 48,797 subscribers 
French: 7,958 subscribers. 
1965 - The journal is reaching 113 countries outside Canada. 
Margaret Kerr resigns as editor. The number of subscriptions 
has risen to 59,985 (English) and 14.196 (French). 
1966 -On April), the entire CNA operation is centralized in 
the new CNA House in Ottawa. 

1975 -In August, Virginia A. Lindabury, editor of The 
Canadian Nurse for the past ten years, resigns, to be succeeded 
by the present editor. 

1979 -In September, official count puts combined 
circulation of The Canadian Nurse and Lïnjìrmière canadienne 
at 132,989. A total of 88,865 nurses in Canada receive copies of 
the English edition of the journal. Close to 2,000 copies are 
distributed in lhe U.S. and abroad. 'V 

input keep more than one maid of all graduate nurse providing the beginnings, but promises to do 
work and often not that. and charges were moderate. I am well. The term of training is for 
true woman cannot and will speaking of the West, where three years. the age limit 21 to 
not see a "home" suffer for there are so many young 30. Candidates come for a 
To the Editor Canadian Nurse. lack of a few extra hours' work. couples and small families month on trial, which may be 
When a nurse goes out of the starting in life, where the extended, and, if necessary, 
There have been cases where city on a case, she finds still charge of $18 a week is a they sign an agreement for 
sickness has come suddenly another kind of life. There are terrible drawback. and yet three years. Our present staff 
in the early part of the day and no conveniences in the farm where the patient could pay a consists of sixteen nurses, 
the servant has left, "bag and house, as a rule, and if it is in smaller amount and not feel which number will be doubled 
baggage" before the nurse the winter time she has to melt under a charity obligation. Of when the new wing now in 
could arrive. Other cases also ice for water and will often course, I know many of the contemplation will be finished. 
occur, where the servant have to do the necessary nurses charge $18 for the first We do not take infectious 
engaged to go to a home, washing to keep things going week and give their services cases, but there is a hospital 
suspecting the mistress of until the farmer can get help, free for say two weeks more, for infectious diseases just 
becoming a mother soon, will but I must say the western but that again places the finished and standing in the 
simply never even let the farmer is as good as a woman patient in the "pauper class". same grounds, to which we 
mistress know she doesn't in the house and can keep Then, there are some nurses hope to send our nurses for 
intend to fill her engagement. house, cook meals, and do a who take a note of hand with special training 
These cases make the nurse hundred things that would be interest for the full amount, We have an X ray 
see the varied conditions of like "Greek" to an easterner. and it takes years to pay it. department and a Finsen light 
work, and she has to be Surely there must be some for the treatment of lupus 
always on the alert for such A Winnipeg Nurse solution to the problem of the cases. We get a great variety 
emergencies. Consequently a wage-earning class to employ of surgical cases, and our 
nurse must be a capable graduate nurses and satisfy operating theatre is used daily 
housekeeper, cook, both sides. If there is not Being the only hospital for the 
companion, dishwasher, a What is the solution? would it not be better for the whole island. we have to 
general "factotum"; also graduates to study this class refuse cases constantly that 
giving the requisite amount of Will some one give information of patient and solve the ought to be admitted, and our 
attention her patient demands, regarding the system carried problem of the employment of number of patients always 
besides keeping an eye on out by the Toronto Registry as "untrained or in experienced equals the number of beds. 
any children there may be and to the payments for nursing nurses, because their charges With kind regards, Believe me, 
seeing they get off to school cases, where full fees cannot are lower?" yours sincerely, 
and are behaving properly. be charged? There are quite a 
, All this seems a number of patients who are M. Southcott, Supt. of Nurses. 
tremendous amount of work unable to pay the regular General Hospital, Sf. John's, 
not called for by the "nursing charge, but who prefer to be Dear Madam, - Our Training Newfoundland. 'V 
code" but it has to be done in nursed in their own homes School is yet in its infancy, and 
the West for the majority of instead of going to the has had difficulties to 
patients are not in a position to hospital, and could afford a overcome incidental to most 

Th. C.n8dl.n Nur.. 

...r,..... t GAn 


Florence Stacpoole. (Bristol: John Wright 
& Co.) 2s. 
"Suffering is not woman's necessary 
lot." These true and simple words are the 
keynote of this book. It is not a book for 
children, but for mothers and aunts and 
others who are. or ought to be, grown-up. 
The author is well known as a lecturer for 
the National Health Society and for the 
Councils of Technical Education, and in 
this book she has stated in clear and 
suitable language the principal 
physiological facts which women 
especially ought to know, and the usual 
causes of various ailments from which 
many women suffer. We have often 
wished for such a book, and there are 
many women to whom it would be a help. 
There is in the preface a necessary 
caution against any attempt at 

Michael Foster, K.C.B., M.P. (London: 
Macmillan & Co.) 1s. 
From his home at Ninewells, in 
England, one of the greatest men of the 
age writes a preface to a little book on 
health he has prepared for the use of 
children in which he tells how he came to 
write it. There are four chapters - Fresh 
Air, Food and Drink, Light, 
Cleanliness-simple with the simplicity 
characteristic of a great mind. This primer 
is a model, and we can only thank the 
"distinguished friend" who induced Sir 
Michael to write it, by objecting to his 
"destructive criticism". 

(Vol.1, No.4, December, 1905). 

}I1U1lrt i!t ill delicious. 
dalntv, healthful dc!!.sert 


ptop'e. children, dys
aWld all people who h.J.ve weak 
. It will be ret.1.incd when no- 
thil1kcl5C will. It'l nourllhinJand quick. 
Iy .uimU.J..ed. 
Patients like it because it i. so d;aintv an.! 
whok!\ome. - 
In tile tl'\lt'lt _nMof rheword Junkct isa "Pure 



, ::



rotn'. No chemicals what!lioe'lo..r are u






p.1ft. fn,,'h milk. In no other form can the nutnti
propcrtiu of milk be 10 Nfcly and enjoyably ulur:n. 
makes I'I:Qui.site. \'eh-etv Ice cream. at small eJ:pen!lll!. TeD 
cents bllvs enough Junker to m"'''e ten Qu...n$. Colon 
and fla' un to sililihe f"ncv. 
Ie by ailleadinilrocen. If youflrQCltr does DOt 
have OUf goods, a,k I1im 10 order them f(lr y04.l. 
.X J07', Little Fan., )I. T. 

22 M.rch 1980 


Nursing practice 


"Some makeshifts", Vol.2, No.2, June, 

Preparation of Room. - Sometimes an 
operation has to be performed in a room 
whose walls are covered with a dirty wall 
paper which cannot be washed, and 
which. if swept. would probably send out 
into the air thousands and legions of 
bacilli and cocci to infect the wound. To 
prevent the dust from flying fill the room 
with steam, by putting into it pans or tubs 
of hot water, and dropping into them 
bricks, almost red hot, this will send out 
clouds of steam. Shut the door at once 
and keep it closed as long as possible. 
Papers spread upon the floor and pinned 
or tacked down will, if there is a carpet 
which cannot possibly be taken up, 
prevent the carpet from being soiled, and 
the dust and infection, lodging in the 
carpet. from being stirred up by the feet 

" A short historical retrospect, 
Montreal General Hospital", VOl.2, 
No.1, March, 1906. 
Perhaps the great difference that would 
strike a stranger on entering the hospital 
would be the size of the wards and the 
neatness with which they are kept by that 
modern institution, the trained nurse. In 
my early student days the wards were all 
small, none holding more than a dozen 
beds, and most much less, and the 
nurses - or Sarah Gamps -I cannot 
describe them! Some were good 
creatures and motherly bodies, all 
uneducated. but mostly kind - which 
was considered a great desideratum. 
The day nurses were fairly good, but the 
night nurses were as a rule 
untrustworthy. One nurse attended to 
three flats, and she often appropriated to 
herself the stimulants deemed necessary 
to support some sinking patient, and if a 
patient was obstreperous he was 
strapped down hand and foot to his bed. 
How different is the conduct of the ward 
now and how carefully each patient is 
guarded and cared for, and how strictly 
our most minute orders are carried out by 
our most zealous and intelligent staff of 

Now the operating room is presided over 
by a nurse who knows more about 
asepsis than the surgeon. who is deeply 
versed in all kinds of instruments and 
their uses, and who knows how to 
prepare sutures and ligatures, dressings 
and bandages, lotions and antiseptic 
paints, so that germs have no place in 
her kingdom, but are driven out by her 
coadjutor angel, Heat. whose fiery sword 
does not drive them to the bottomless pit, 
but destroys them utterly. 


"Our responsibility re Tuberculosis", 
Vol.2, No.1, March, 1906. 

The great battle of the twentieth century 
against tuberculosis demands the help of 
every trained nurse. The average nurse 
has very little opportunity for studying 
phthisis in its incipient stage owing to 
restrictions in many hospitals against 
accepting tuberculous cases, and 
generally regards a consumptive as an 
emaciated, coughing, and hopelessly ill 

Nurses must fully comprehend a few 
leading facts about consumption. The 
person suffering with tuberculosis may 
not be a "patient". He may be a visitor to 
the family, or one of the household who 
"has a cold that he cannot shake off," or 
who "seems to have a slight cough, but 
does not think anything of it," or who is 
"run down and has indigestion and feels 
lazy all the time." 

Let the nurse be ready to speak quietly 
but firmly and tactfully to the one who has 
aroused her attention, and urge him to 
see his physician, pointing out that 
serious lung trouble may sometimes first 
manifest itself in that way. If this were 
done throughout the country surely many 
and many a man or woman, acting on the 
trained nurse's suggestion, would consult 
his medical adviser and his disease 
would be discovered before his chance of 
recovery was gone. 

"Count the forceps", VOl.1, No.3, 
September, 1905. 
On June 1 st, 1902, a patient was 
admitted to be operated on for an ovarian 
cyst. The patient was a woman weighing 
one hundred and seventy pounds, and 
there were many adhesions. Sutures 
were removed on the seventh day, and 
patient went home on the twenty-first 
day. During the next two years the patient 
lost flesh rapidly, was troubled with 
constant diarrhea, and had different 
medical men to attend her. but without 
relief. On June 4th, 1905, patient passed, 
per rectum, one handle of an artery 
forceps. and on the following week was 
brought to the hospital, where a second 
incision was made and the other part of 
the forceps removed from the intestine. 
Patient improved for two days, then died 
of post-operative peritonitis. 
Some people severely criticize the 
nurses for not counting the forceps. 
There were four doctors present. 
Forceps are now counted in this hospital 




Volumes could be written on the question 
of prevention of waste in hospitals, and 
many of us could contribute from our own 
practical experience and observation 
what would help to lessen the 
expenditure, especially for food. Some 
hospitals dispose of their food garbage to 
contractors for stipulated sums. 
In one hospital at least in Canada, 
where the white of the egg only is 
required for making drinks, the yolk is 
consigned to the garbage pail. Waste - 
willful waste. The yolks should be put in 
water and sent daily to the kitchen where 
they could be used in the making of 
puddings, cakes, salads, omelets, etc. 
Waste, breakage. misappropriation. 
How can these conditions be remedied or 
improved? No amount of worrying or 
scolding will improve matters - but if the 
value is known, then responsibility and 
economy will be practised. 

NUrSing education 

In our little training school of ten pupil 
nurses we have an admirable course of 
lectures, extending over eight months of 
each year, and on the following subjects: 
Anatomy and physiology, 12; materia 
medica and therapeutics, 6; hygiene. 
toxicilogy and medicine, 9; surgery, 6; 
gynecology, 4; obstetrics, 6, and urinary 
analysis, 4. 
With one lecture a week, it is obvious 
that these cannot all be given in one 
session: so my plan is to have them 
cover two years. One evening each week 
is devoted "to class work with the 
Superintendent, where the Public School 
Anatomy and Physiology, with 
Hampton's "Nursing". are the text-books. 
This is also the time for talks on ethics. 
hospital etiquette and kindred subjects. I 
begin each session with the younger 
nurses, but all attend except the senior, 
who relieve during class. Then on lecture 
night the juniors relieve, and all the 
second and third-year nurses attend. 
One evening each week is thus devoted 
to class work, and one to lectures. I find 
this plan works out very well. 
We have a diet kitchen, but I regret 
that I have not yet been able to arrange 
for any special instruction in dietetics. 

From an Ontario Hospital, "The 
Contributors' Club", Vol.1, No.3, 
September, 1905. '" 


During the early part of April 
Winnipeg suffered from a 
street car strike which, for a 
week, tied up the service, and 
was decidedly inconvenient 
for the District Nurses and the 
Victorian Order Nurse. The 
only satisfaction they got out 
of it was the fact that the men 
cheered them and 
encouraged them "to walk", 
which was really hard work, as 
Winnipeg covers an immense 

The Secretary of War, Mr. 
Haldane, has been asked in 
the House of Commons why 
military nurses should not be 
allowed to go to dances. Mr. 
Haldane explained the evil 
effects of late hours. Nurses 
have been expressing 
themselves in their own paper 
to the effect that the 
discussion was unnecessary, 
as no good nurse on duty 
wants to go to balls. 

The Training School for 
Nurses in connection with the 
Hospital for the Insane at 
Brockville, has closed its first 
year with gratifying success. 
Arrangements have been 
made to have the 
examinations conducted 
uniformly with the Asylum 
Nurses' Branch ofthe British 
Association. so that graduate 
nurses will be recognized as 
members of the British 
Association. This arrangement 
will likely be very satisfactory, 
and the Brockville institution 
deserves credit for taking the 
lead in Ontario in securing 
recognition to Canadian 
nurses who train in this special 
work of nursing mental and 
nervous cases. 

Did you know? 
During the past year no less 
than 39,223 patients were 
treated in the hospitals of 
Ontario? There are now 64 
public hospitals in Ontario 

Th. C..""dllln Nur.. 




D _.. 

Bed and Douche Pan 



d in More Thon 1000 HO.lp;tol.l 

...ecom...... n .... 
Tho......n.. af 
Tratned 'IIIur__ 


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........... r .. 
Lew.. 111_"__" ...._. 
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.... I ............... S.......... 51_ 'I 10 __ 
"..1 . Ch.I... S'.. . . ..00 ... 
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.......a..I I.......... ....' 5.75 .. 
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...... ..a..._....... __.""........ _........ 
HQ.4_i,.'. S.._"Ii.tI.'I Wk'...'. PrÑ:'" 


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",:'uu NEW YORK 

Professional Image 

Trained nurses are regarded by the 
public with very mixed feelings. As a 
class their position, and the good they do 
in the hospital is now unquestioned, 
although individuals may be prejudiced 
against some particular nurse and her 
ways. But outside the hospital the trained 
nurse is still regarded as a not altogether 
unmixed blessing, and the public will 
need several more years of education - 
in which, perhaps, proper legislation by 
which the standard requirements for 
members of the profession will be more 
precisely defined, will be of no little 
assistance - before they can be brought 
to thoroughly appreciate her position or 
the relative value of the services of the 
trained nurse, and those of the untrained 
attendant and the well-meaning, 
enthusiastic, but untaught amateur. 

And after years of toil, after nurses as 
individuals, and as a united profession 
have shown themselves to be necessary 
for the public welfare, it will most 
assuredly come about that more and 
more people will come to the conclusion 
that capability in nursing does not come 
by chance, and that a natural liking must 
be supplemented by education and 
practical training; they will gradually 
appreciate the fact that a trained nurse 
has spent time, money and much 
physical effort in acquiring her education, 
that the mental and physical strain of the 
work are more arduous than perhaps any 
other kind of work done by women, and, 
therefore. that this expenditure deserves 
suitable recognition at their hands. '" 

March 1980 23 

A little crystal ball gazing 

Nursing in the year 2000 - what 
will it be like? To find out, CNJ 
asked some of today's nurses to 
do a little crystal ball gazing and 
let us in on what they saw. 

Helen Taylor, president of CNA 
for the past two years and director 
of nursing at Montreal General 
Hospital, sees nursing as 
changing in response to societal 
pressures: "In keeping with the 
belief that health is a fundamental 
human right and that every person 
should have access to a complete 
range of health services and 
social services from the cradle to 
the grave, nurses will be expected 
to assume increased 
responsibilities as our health care 
structures change to meet these 
goals. These responsibilities will 
include more primary care settings 
in which nurses provide 
management of therapeutic 
regimens, education and 
"Nurses will also be expected 
to take more responsibility for 
coordinating care, for promoting 
the continuity of care and for 
intervening in crises situations. As 
more nurses move into a greater 
variety of settings - family 
practice settings both inside and 
outside of hospitals, group 
practice centers, occupational 
health programs - they will 
become more independent and 
will be direclly involved in complex 
decision making. Nurses will 
become more innovative and 
creative as they learn community 
skills such as consultation, 
community organization, 
convening of various service 
networks, monitoring 
environments and collecting and 
communicating feedback 
information. The nurse 
epidemiologist will carve out a 
special role for herself. 
"As our youth-centered 
society becomes more 
adult-oriented, attention will focus 
more on the needs of the aged 
and chronically ill. Emphasis on 
acute illness and efficiency will 
lessen and more of our efforts will 
be directed to control instead of 
cure, to management rather than 
total recovery. By the year 2000, 
the special nursing skills required 
for care of the elderly and the 
dying will be more fully 
appreciated. " 
Taylor predicts an expanded 
role for nurses at all levels of thE' 
health care system: "They will be 
planners, administrators, 
specialists, generalist 
practitioners, teachers, evaluators 

and researchers. Nurses will have 
even greater responsibility for 
utilization and interpretation of 
technological monitoring devices 
and for functioning in lifesaving 
and life-sustaining situations. 
Nurse managers, particularly in 
hospitals, will have increased 
skills in budget control, labor 
relations and computer 
programming. Nurses will see 
their roles overlap more and more 
with those of Other professions 
and will develop increased ability 
for interprofessional and 
intraprofessional consultation. 
Just as their knowledge will need 
to be wider and deeper and their 
collaboration with others more 
sophisticated, attention to 
standards and quality will have 
increased importance. Basic 
baccalaureate preparation for the 
professional nurse and continuing 
education programs will become 
the order of the day." 

Sheila Embury of Edmonton, one 
of the few nurses in Canada 
elected to public office, is a 
Member of the Legislative 
Assembly of Alberta. She agrees 
with the CNA president that 
baccalaureate preparation will be 
the minimum requirement for entry 
to the profession by the year 2000 
and predicts that by then one 
nurse in ten will have completed 
studies at the master's or doctoral 
level. (The current figure is one in 
"Educational opportunities 
will have expanded so there are 
more avenues for health care 
workers to move upward: 
technicians becoming 
professionals and baccalaureate 
nurses moving on to graduate 
studies, majoring in clinical 
specialties and a variety of other 
disciplines such as business 
administration, computer 
sciences, medical technology and 
political science." 
What about independent 
practice, job satisfaction and 
salaries? Embury predicts that by 
the turn of the century one nurse 
in 20 will be in private practice. 
working alone or in a clinic, 
consulting in direct client care, 
conducting home visits and doing 
patient teaching. 
"After a prolonged and 
difficult struggle. some nurses In 
some provinces will be permitted 
to collect fees from provincial 
health care payment schemes. 
Salaries will improve, too. as the 
competitive market for nurses is 
strengthened by the number of 
nurses employed by private 

enterprise (occupational health). 
As salaries improve, there will be 
higher patient and client care 
standards and greater personal 
accountability on the part of each 
individual nurse to evaluate her 
own care for her clients. 
"Job satisfaction will be high 
even though we will see a great 
deal of mobility across Canada. 
Nurses will work a four-day week 
(or less). Although salaries will be 
higher and nurses will have the 
satisfaction of earning more 
money, the cost of living will 
continue to rise and a higher 
proportion of nurses' salaries will 
go into taxes. 
"The practicing nurse in the 
year 2000," Embury concludes, 
"will be an integral part of the 
health care system and will have 
attained a correspondingly high 
status level as a result of her 
professional contributions." 

"The key person in making health 
care - the promotion and 
maintenance of healthful lifestyles 
and the prevention of illness - 
accessible, available and 
affordable to all." That's how 
CNA's executive director. Helen 
K. Mussallem. sees the nurse in 
the year 2000. Her vision focuses 
on "the nurse who is the initial 
contact for everyone in her 
segment of the community." 
Between now and the turn of 
the century, Mussallem predicts, 
Canadian nurses will recognize 
their opportunity and responsibility 
to work within the framework of 
government policy to expand the 
health component and change the 
course of events that presently 
encourages misuse of illness 
centers such as hospitals and 
emergency facilities. Working 
through their national 
organization, nurses will develop a 
new model of health services that 
are, in fact "accessible, available 
and affordable" to all citizens. 
They will be assisted in this effort 
by the spirit of government policy 
developed following the national 
"Health Services Review of 
"The primary health care 
facilities of the year 2000 will be 
similar in principle to those 
envisioned in the early 1980's, 
except for the fact that they will 
also act as education centers for 
individuals chosen by their 
community to become health care 
workers. These workers will assist 
the nurse who will be the initial 
contact for persons in her 
segment of the community. 
Eventually, each city block. rural 

area and isolated community will 
have its own complement of 
persons 'at their elbow' who can 
provide health guidance and act 
as 'interpreters of service' for the 
health centers." 
The primary health care 
programs developed by Canadian 
nurses will, Mussallem predicts. 
be recognized by countries all 
around the world which are 
seeking ways of achieving the 
target of the World Health 
Organization - "Health for all by 
the year 2000". These 
governments will invite Canadian 
nurses to assist their own health 
personnel in developing and 
implementing similar plans in 
these countries. 
"In this way. by the year 
2000, Canadian nurses will have 
spent two decades in assisting 
with the development of policies 
and programs that helped to win 
the struggles for universal health 
- in Canada and abroad." 

In a lighter vein, New 
Brunswick nurse, Arlee McGee of 
Fredericton. tries her hand at 
poetry to forecast the fate of 
nursing in the year 2000: 
"What of the Nightingales of years 
that are past, 
Can the crystal VIal telt us how 
they fared? 
The nurses of yesterday are in a 
broad range 
They correlate health with the 
stresses of change. 
They delve into research and 
direct the whole plan. 
As 'Careo/ogist Consultants', they 
know about man. 
They know about needs, 
emotions and feelings. 
They advise the technicians on all 
client dealings. 
The picture fades... but there's 
one more view... 
50 The Driveway. What's this? 
Something new? 
A microwave tower emits to the 
Holistic Health from our own TV 
Unique public programs appear 
every day 
Under now famous call letters- 
But the last word goes to CNA 
president Helen Taylor who 
summed it up this way: "Above all, 
wherever nurses work in the year 
2000, they will maintain the 
essential caring role that has 
always been the substance of all 
nursing functions and activities." ... 

24 Merell 1980 

Th. CanadIen Nur..a 

When you choose a nursing dictionar
rely on the choice of the most discriminating, 
most sophisticated, and hardest-to-please critics- 
your colleagues. 

Over 575.000 of your colleagues have selected the 
13th edition of Taber's as their trusted nursing 
And that continues a tradition that began back in 
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Medical Dictionary appeared. Since then Taber's has 
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. It teaches pronunciation. Phonetic spelling is 
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Published in U.S.A. by 
,.. 1915 ARCH STREET 


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English) to aid in diagnosis and treatment of 
patients with an English language barrier. 
. Its first aid information gives you the accepted 
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Plus these and many other features; etymologies; 
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Other nursing dictionaries come and go. but Taber's 
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Phoro courtesy orVancou\'erGencral Hos 
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Laura Barry 
Treatment of this often telTifying disease which renders young and healthy 
people nearly totally paralyzed for weeks or months is palliative, and depends a 
great deal on good nursing care. The author discusses the importance of the 
triangle ofnurse-patient-family, and how to use this relationship to the utmost 
;n creative caring. 


Guillain-Barré Syndrome is also known 
as acute infectious polyneuritis, acute 
polyradiculoneuropathy, or the 
Landry-Guillain-Barré Syndrome. The 
unusual nature of this disease lies in the 
fact that it attacks people who are 
apparently healthy and vibrant, leaving 
them totally dependent on others for 
their very ex istence. 
The main factor in the etiology of 
this disease seems to be the fact that 
lhere is an unusually high incidence of its 

24 lIelch 1980 

The Cenadlen Nur.. 

occurrence after a viral infection, or a 
patient's receiving influenza vaccine. 
However, no real cause and effect 
relationship has been established 
between the vaccines and 
Guillain-Barré. After an infection, the 
body could produce antibodies which 
attack its own myelin; these antibodies 
then attack the nerve roots as they exit 
from the dural space, resulting in patchy 
degeneration. Lymphocytes accumulate 
at these sites and occasionally cause 
inflammation great enough to compress 
the nerve. Serum proteins transude into 
the subarachnoid space and the 
cerebrospinal fluid. which produces a 
rise in protein in the CSF. I 
Guillain-Barré Syndrome is not 
specific to anyone age group: it affects 
infants as well as the elderly. Although 
no actual figures are cited, most medical 
literature states that more males than 
females are afflicted. 
Onset occurs generally within two 
weeks after a viral infection (influenza. 
infectious mononucleiosis or an upper 
respiratory infection or tonsillitis). 
Frequently, the initial complaint is of 
"stocking-glove" parasthesia, or of 
facial weakness and weakness ofthe 
muscles in the lower extremities. Cranial 
nerve involvement occurs in some 50 per 
cent of the cases; involvement of the 
vagus nerve, the principal 
parasympathetic nerve in the body, leads 
to widespread autonomic nervous 
system dysfunction. 

The syndrome is self-limiting. and 
recovery generally begins within two to 
three weeks after the disease has reached 
its zenith.The recovery process works in 
reverse of the disease symptoms; it may 
take from six months to a year for a 
patient to recover all muscle strength. 
Because any disease named a 
'syndrome' is a collection or set of signs 
and symptoms that appear with 
reasonable consistency, certain critelÍa 
have been established for making the 
diagnosis ofGuillain-Barré Syndrome. 
I hese are;3 
· progressive motor weakness of 
more than one limb, ranging from 
minimal weakness to total muscle 
paralysis. Signs of weakness develop 
rapidly but cease about four weeks into 
the illness. 
· areflexia. 
· relative symmetry of symptoms. If 
one limb.is affected. the opposite one is 
as well. 
· mild sensory signs or symptoms. 
· cranial nerve involvement. This 
occurs in 50 percent of patients and is 
frequently bilateral. 
· recovery usually begins two to four 
weeks after progression of disease 
symptoms has ceased. 
· autonomic dysfunction. such as 
tachycardia or other arrhythmias. 
hypertension. postural hypotension all 

support the diagnosIs. 
These are the principal signs of 
Guillain-Barre Syndrome, but other 
signs may exist in a number of patients: 
. fever at onset. 
. severe sensory loss with pain. 
. progression of symptoms beyond 
four weekso 
. progression may cease without 
recovery . 
. sphincter function is not usually 
affected but in some cases transient 
bladder paralysis may occur. 
. CNS involvement. The disease is 
thought to involve only the peripheral 
nervous system, but there has been some 
evidence ofCNS involvement as well. 
There are only a few laboratory 
diagnostic procedures necessary for the 
diagnosis ofGuillain-Barré Syndrome. 
Of prime importance is examination of 
the cerebrospinal fluid, obtained by 
lumbar puncture, for protein levels. 
Often the CSF will appear normal, but 
the IOtal protein is increased. A white 
cell count and sedImentation rate are 
useful, but often they will be within 
normal limits, unless still affected by the 
patient's previous illnesso. Pulmonary 
function tests may be done to assess the 
degree of paralysis in respiratory 
muscles. Nerve conduction studies too 
may determine which nerves are 
Treatment ofGuillain-Barré is 
palliative and supportive. At this point in 
time. there is no known treatment or 
drug that can halt the disease process 
and speed the patient's recovery. 
Steroid therapy has been tried, but 
its use is as yet controversial. The 
principle behind the use of steroids is 
their ability to control autoimmune 
response, but the value of this therapy 
in Guillain-Barré Syndrome has not been 
established.. 5 
Ventilation assistance may be 
required depending on the degree of 
respiratory embarrassment from 
muscular weakness. 
One cannot overlook the importance 
of good nursing care in the treatment of 
patients with this disease: frequent 
turning, good skin care, chest 
physiotherapy, passive exerc"ises and 
accurate monitoring are all of vital 

The nurse-patient-ramil
The relationship between the nurse, her 
patient and the patient's family is 
important in the treatment of any disease 
and subsequent rehabilitation, but 
especially so in Guillain-Barré 
Syndrome. Not only must the patients 
with this disease endure an intense 
physical adjustment, but they must make 
a profound psychological one as well. 
The patient looks to the nurse to meet 
her physical needs just to keep her alive; 
Guillain-Barre Syndrome is no less 
agonizing for the family. Often they wish 

The Canadian Nur.. 

they could trade places and alleviate 
their loved one's suffering. They feel 
helpless as they watch their spouse, 
parent or child go through stages leading 
to eventual acceptance, similar to the 
five stages of accepting death. 
Consider this - you are a healthy 
young girl. The only recent medical 
problem you've had is a little cold. Now 
you have a "pins and needles" sensation 
on your hands and feet and are feeling 
weak; the doctor is telling you that this 
may progress to the point where you 
require a tracheotomy and a respirator 
just to breathe! You think to yourself- 
"not me,l'm healthy". 
It must be a tenifying experience. 
You keep denying the fact that you are 
suffering from this disease but all the 
while you are getting weaker and 
weaker. "No,/t Can't Be Happen;n!: To 
M ," 
Unfortunately. the diseao;e 
progresses to the point where the patient 
can no longer use verbal denial as a 
defense mechanism. and anger takes 
over: "Why me !?" This anger is a 
natural protective mechanism, not a 
personal attack on anyone. It is directed 
at the disease itself and the nursing staff 
must keep this in mind, for if they 
interpret the anger as a personal attack, 
they will become frustrated with and 
resentful of the patient. 
The point at which the patient 
realizes she cannot control her disease 
and that she has no choice but to see it 
run its course is when she begins to 
bargain with the nurseso The realization 
that she has lost control, however, 
frequently leads to depression which, in 
the case of the patient with 
Guillain-Barré Syndrome, can be 
overwhelming. The patient needs a great 
deal of support , from both nuro;es, 
friends and family. if he or she is to pass 
through this stage successfully. Support 
doesn't have to be a soliloquy of 
encouragement - just spending time 
with the patient, just touching. are as 
effecti ve . 
With good nursing care and 
emotional support, the patient with 
Guillain-Barré Syndrome can reach a 
stage of acceptance; hopefully, by this 
time the disease will have reached its 
zenith and ceased to progress further. 
But what exactly makes a good 
'nurse-patient-family relationship '? 
Without some concrete suggestions, this 
phrase isjust an auspicious-sounding 
title for something that mayor may not 
truly exist. What factors contribute to 
the development of a good, therapeutic 
nurse-patient-family relationship? 
One must look first at what the 
nurse contributes. She is an individual. a 
person with her own set of moral 
standards and values; she has her own 
unique ideas of what a nurse should be. 
Too often though. the nurse has 
unrealistic expectations of herself. She 

tries to be all things to all people and in 
the end, drained both physically and 
emotionally, she can no longer help the 
people she wants to. The nurse fills a 
variety of roles: she can be a social 
worker, mother, problem-solver and 
healer, all in the course of one day. 
Unless she looks after her own needs 
too, and recognizes the potential drain 
on her system, she may become merely a 
task-oriented functioning unit - an 
apathetic frustrated shello 
The patient, second partner in the 
relationship. is an individual too and his 
or her contributions to the interactions 
are affected by his own cultural 
background, moral standards, his 
perception of disease and by the nature 
of the illness itself. Obviously the degree 
of alertness or awareness on the part of 
the patient is going to be a major 
determinant in what he can contribute 
to any relationship; a comatose patient 
will not be able to contribute a great deal. 
The third member of the 'triangle' is 
the family whose importance should not 
be underestimatedo Depending upon the 
closeness ofthe family unit, lhe family 
and the patient can sometimes be 
considered as one entity. Frequently 
doctors and nurses alike feel as though 
they are treating the family as well as the 
patient. The family's contribution to the 
nurse-patient relationship is immense. At 
times, the family can act as a pivotal 
point around which the nurse can 
function; they may be invaluable a:. a 
source of information, for example. The 
family's needs must be considered too 
and met in order to promote a 
comfortable environment for all 
By recognizing the importance of 
the family unit, the nurse can see how 
the family can help or hinder a patient's 
acceptance of her condition, how they 
can support or undermine the intentions 
of the medical and nursing staff. If the 
nurse does recognize the family's 
importance, then she can use it to her 
Once the triangular relationship 
between nurse. patient and his family has 
been recognized and assessed, how does 
the nurse caring for the critically ill 
patient with Guillain-Barré Syndrome 
enhance this relationship to work for the 
benefit of the patient? 
It has been said that language is 
God's gift to man, and certainly, in the 
hospital as nowhere else, communicalion 
is of prime importance. 
The nurse should converse in a 
calm, reassuring manner at all times. 
exhibiting not only her professionalism 
but the fact that she too is an individual 
who cares. While guiding conversation, 
she should give opportunity for patient 
or family to ask questions; answers 
should be as specific as possible, not 
broad generalizations that might apply to 
anyone.lnterdctions should be 

28 Merch 1980 

encouraged, not cut off. Phrases such as 
"yes, go on." or repeating what a person 
hasjust said show that the nurse is really 
listening and interested in what she has 
Needless to say, it is just as 
important for the patient and his family 
to be good listeners, but when anxiety 
levels are high. understanding and full 
comprehension of all that has been said 
by nurse or doctor is often difficult to 
achieve. Staff should be aware ofthis, 
and be ready to repeat information if 
necessary . 

Also true is the edict that "actions 
speak louderthan words". In the 
working phase of a good 
nurse-patient-family relationship, all 
three partners work together toward a 
common goal. Although not always the 
case, family members are usually eager 
to assist in the care of their loved ones. 
Helping the nurse with such simple tasks 
as the daily bath or making the bed can 
make a family member feel that there is 
something he or she can do to help, even 
in this overwhelming situation. The 
family will not feel they have 
relinquished ownership of the sick 
individual to the hospital. 
Nurses tend to react to 
Guillain-Barré Syndrome on two levels: 
first, from a humanistic point of view ,it 
is difficult to watch this disease attack a 
healthy young person and gradually 
render them totally immobile and 
dependent upon machines and 
care-takers for their survival. Secondly, 
nurses look at the illness from a medical 
viewpoint, recognizing that the patient is 
a challenge to all the nursing skills they 
possess. Hopefully, these two different 
outlooks can be integrated. 

Linda- A Case Study 
Linda wasjust 20 years old when she 
was admitted to hospital with !.igns of 
Guillain-Barré Syndrome. Her earliest 
symptoms were a "pins and needles" 
sensation in her legs and arms, feeling of 
thickness in her tongue and loss of sense 
of taste, nausea and vomiting and 
weakness of girdle muscles, all of which 
occurred rapidly in a 48-hour period. 
Noting her past history, the 
admitting physician wrote in her chart 
that Linda had had infectious 
mononucleiosis five years previou
ly but 
had been well until three weeks before 
admission when she had caught a cold 
which lasted for about two days. One 
week before admission she had had a 
wisdom tooth or third molar extracted 
under local anesthesia. 
What follows are excerpts from the 
medical progress notes which indicate 
the development of Linda's illness. 

30/5/77 Patient admitted. On 
examination: sensory. Touch 
intact; vibration. intact; pinprick. 

The C.nadl.n Nur.. 

parasthesia extends 2 inches 
above knees and 6 inches above 
Reflexes decreased both sides, 
Babinski not evident. Gait - can 
no longer walk, too weak. 
Motor strength decreased both 
5/6/77 Motor weakness slowly 
6/6/77 Tracheotomy performed. 
7/6/77 Patient put on respirator at 0400 
hours due to respiratory distress. 
9/6/77Mild improvement of'neuro' 
10/6/77 Gradual improvement of 
polyneuropathy beginning. Main 
problem now is dependence on 
respirator which is probably 
20/6/77 On assisted ventilation during the 
day and on automatic ventilation 
at night. She is nervous when off 
respirator, has tendency to 
26/6/77 Continues to improve in muscle 
strength in all extremities. 
2/7/77 Tracheostomy tube corked. 
4/7/77 Tracheostomy removed. 
15/7/77 Progressing well. Eager to go 
home and pushing herself. 
22/7/77 Dischargedo 

I n reading these notes, one can see 
how Linda's illness followed the pattern 
described earlier for the development of 
this disease: gradual worsening to a 
peak, and then improvement, slow at 
first, but soon more dramatic. She was 
hospitalized for a total of seven weeks. 
during half of which she was almost 
completely without voluntary 
After Linda had returned home, I 
interviewed her. her family and the staff 
nurses on the unit where Linda had been 
hospitalized, to discover how the 
nurse-patient-family relationship had 
figured in her supporti ve care. 
Linda said, "My family played a 
very big part in my time in the hospital 
and if the family is willing,) think they 
should be included in most aspects of 
hospitalization... .. Her father 
commented that "Our role was 
supportive, we could do nothing ebe. 
We wanted to be there at all times and 
we felt she wanted u!. to be there." 
For the nurses, an honest appraisal 
of the experience led them to admit that 
although Linda's hospitalization had 
ended successfully, there had in fact 
been times when the nurses' relationship 
with both patient and family had been 
Looking back helped them to 
understand what they had done when 
things were going well. and what had 
ed things to go wrong. 

One nur!.e outlined the problems she 
felt important in caring for Linda: she felt 

frustrated when she was unable to 
understand what Linda was trying to tell 
her, and she often felt unable to alleviate 
her fears. Difficulty in making Linda 
physically comfortable was expressed 
too. and in helping her to cupe with 
certain things that had to be done such a
tracheotomy care and suctioning. 
Helping the family to understand the 
illness and assisting them in coping with 
it was another problem. But underlying 
all these problems was the very basic and 
frightening knowledge that Linda 
depended totally on the nursing and 
medical staff for survival. 
Another nurse listed what she 
thought Linda's emotional needs had 
been during her illness: there was the 
need to talk and to be listened to, to feel 
safe. to be free of pain, worry and 
fatigue, to feel accepted despite her 
condition, and the need to be 
The nurses wished they had had 
more conferences about Linda's care: all 
the nurses interviewed realized the 
importance of these conferences, noting 
that they benefit not only patient care, 
but meet the nurse's needs as well. By 
talking with their peers, nurses come to 
realize that it i.. alright to get angry and 
frustrated at times. They realize that 
lhey need not feel guilty about these 
feelings and they become aware of the 
dangers of always suppressing their ill 
feelings. Nurses are human after all, and 
everyone has "bad" days; it is 
comforting to know that one is not alone. 
A nursing conference can give a nurse 
the encouragement she needs to go out 
and try one more time. 
One nurse in particular noted the 
fact that the patient with Guillain-Barré 
Syndrome requires a consistent 
approach from nurses, and in retrospect, 
she had a suggestion: 

.. Perhaps there could hlll'e been a 'core 
Rroup' of nur.
es assiRned to Linda. For 
erample, a group of six or eiRh1 nurses 
could hal'e been selected Ii'hen Linda 
 firM admitted. The schedule could 
hlll'e been planned or the nurses pic/..ed 
from the rotation so that one of the 
 would alway.
 hm'e been 
on dUlY, .. 

Other nurses involved in Linda's 
care said they had at times felt resentful 
of or actually afraid ofthe family's 
presence, but at least one was finally 
able to understand the family's position: 

"1 li'anÚd to ma/..e Linda and her family 
more at ea.
e and comfortable. I thoulfht 
a lot abollt how I would feel in Linda's 
position and came to the condu.
ion that 
I would Ii'am the same Mnd ofthinlfs- 
one bein[< my parents near by. ., 

And, as Linda's father said, the 
family wanted to be near Linda too: he 

spoke of the hope the nurses gave him 
and his wife, and felt the nurse's air of 
confidence and faith in Linda's treatment 
to be important. It was a time of great 
trial for Linda's family: 

"Almost instanely it seemed a healthy, 
I'ibram, aware girl is tram.formed imo a 
being thar was so immobile .
he could not 
fully close her eyes. RollinR her ol'er was 
like trying to mOl'e a RarbaRe bag full of 
water. A machine was pumpinR air into 
paraly;:ed lungs. Not only couldn't she 
ral/.., almost all communication came to 
a halt. 
To the family, this is mind-bending." 

It was evident that a trusting 
relationship between Linda and her 
nurses was necessary for her to be able 
to regain her independence, even after 
the worst of her illness was over. I n the 
doctor's notes. her psychological 
dependence on the respirator was 
well-documented. and the nurses had to 
work hard to encourage Linda to wean 
herselffrom the machine. Knowing that 
the nurses would not force her to do 
anything before she was ready was 
important to Linda; they made her feel 
that the choice was hers - she could 
stay off the respirator for as long as she 
felt it wa<; possible. 
.. o..Nobody wam.
 to .Hay attached 
to a machine forel'er. When the nurses 
explained that the tests .\llOwed that I 
Ii'as MronR enouRh to breathe 011 my 
011'11, I didn't Ii'am the machine any 

What does it all mean? 
In a disease like Guillain-Barré 
Syndrome where the treatment can only 
be supportive. that basic philosophy of 
care applies to both physical and 
emotional care. For nurses, this means 
not only using basic nursing skills to their 
utmost, but developing a good 
relationship with the patient and her 
family to support everyone through to 
the resolution of this frightening illness. 
A good nurse-patient-family 
relationship can have excellent 
therapeutic effects, and it behooves 
every nurse to be aware of how she can 
foster such relationships. 
Linda's father spoke of what he 
thought the care given to his daughter 

"Good lIursinR...is enliMinR all the 
help you can Retfrom the patiem,family 
, and then with (the nurse) as 
the focal point willin[< the patiem to Ih'e 
with .111 the .Hrenlfth you can muster. All 
 lIurses in Imensil'e Care did 
jU.H that - thev cared. imemil'elv." oW 
. - 

I Gilroy, John. Medical NeuroloR-v, 
by John Gilroy and John S. Meyer. 2nd 
ed., Toronto, Collier-Macmillan, 1975, 

2 Ibid. 
3 *Plum, Fred. (editor)Annals of 
neurology, 3:6, June 1978, p0565-566. 
4 Gilroy,opocit., p.668. 
5 Ibid. 

1 *American Association of 
Neurosurgical Nurses. Core curriculum 
for neurosurgical nursing. Baltimore, 
American Association of Neurosurgical 
Nurses, 1977. 
2 Brunner. Lilian Sholtis. T ext hook 
of medical-surgical nursing, by Lilian 
Sholtis Brunner and Doris Smith 
Suddarth. 2nd ed. Philadelphia, 
Lippincott, 1970. 
3 Carini, Esta. Neurological and 
neurosurRicalnursing, by Esta Carini 
andG. Owens. 6th ed. St. Louis, Mosby, 
4 Erikson, Erik H. Childhood 
society. New York, Norton, 1964. 
5 Gilroy,John. Medical neuroloR\', 
by John Gilroy and John S. Meyer, 2nd 
ed. Toronto, Collier-MacMillan, 1975. 
6 Kubler-Ross, Elisabeth. On death 
and dyinR. Toronto, Collier-MacMillan, 
7 Lewis. Garland K. Nurse-patient 
communication. 2nd edo Dubuque, Iowa, 
Wm. C. Brown. 1973. 
8 *Lockemy, Florence K. 
C ommunicatiollfor nur.\e.L 3d ed. St. 
Louis, Mosby, 196K 
9 O'Brien, MaureenJ. 
C ommunicatiom and relatiomhips in 
nursing. St. Louis, Mosby, 1974. 
10 *Plum, Fred (editor). Aflflllls of 
neuroloRY. 3:6. June 1978. 
II Travelbee, Joyce. Imerpersonal 
 of nur.
ing. Philadelphia, Davis 
Co., 1966. 
12 Ujhely. Gertrud B. Determinams 
of the nurse-patient relatiomhip. New 
York, Springer, 1968. 
13 -. The nurse and her prohlem 
patients. New York, Springer, 1963. 

*Unable to verify inCNA Library 

Laura Barry is a [<raduate of George 
Brown ColleRe in Toronto, St. Michael's 
Hospital campus and has recently 
completed the post-basic clinical 
proRram in N eurologicaland 
NeurosurRical NursinR lit the Montreal 
Neurological Hospital. She is curremly 
workinR on staffat the MomrealGeneral 
Hospital. in the neuro unit. 






_ of an alternative 






.. ,
- - III 
I 'II 
, ----.., 
{ t\ 

, , , -" 
Traditional deli
ery ro8l11 




Ellen L. Rosen 

Last October, CNJ featured a special section called Childbirth Today in which several nurses spoke 
of the need for alternate birthing procedures for their patients. Here is how 
one hospital with a family-centered philosophy implemented the concept of the Birth Room. 

The recent rise in consumer interest in 
childbirth practices has led to the 
development of several alternative 
delivery methods: a small group has 
chosen home delivery as their 
alternative. but the majority- 
recognizing that the hospital setting 
provides the maximum opportunity for 
physical safety and psychological 
well-being - have been working to 
encourage hospital administrators and 
physicians to otTer a more satisfying 
birth experience within the hospital. 

!ch 1980 

The rationale for these consumer 
demands varies: the most frequent 
complaint refers to the sterile 
institutional appearance of the average 
hospital delivery room which many 
patients say increases their anxiety, and 
suppresses the natural expression of 
emotion in the birth process. Women add 
that they feel the excitement of the 
moment is sometimes lost in the sterile 
environment, and they reject the 'sick' 
role inferred in becoming a patient in 


Another common complaint derives 
from the transfer from labor bed to 
delivery table necessary in 
traditionally-designed labor-delivery 
areas. In most hospitals, labor is 
managed in one room and delivery in 
another; however, this practice 
interrupts the continuity of birth. 
Practically, mothers find it very difficult 
and uncomfortable to move from one bed 
to another at a time when they should be 
devoting all their energy to the 
experience of giving birth. 


Complaints in general reflect a 
desire on the part of women to have 
more control over their labor, and to be 
more actively involved in the 
management of their labor and birth. 
They wish to "deliver" the;r babies, 
rather than to "be delivered of' infants. 
As a logical extension of the 
family-centered philosophy of 
maternal-child care of our hospital, the 
Victoria Hospital in London, Ontario, a 
combined labor/delivery room seemed to 
us to be an idea that was worth trying. 

Prior to actually planning the facility, we 
had to undertake several pre-planning 
activities, including ward conferences 
with staff nurses and meetings with the 
chief of the obstetrical service and the 
nursing service co-ordinator. Their 
cooperation was essential and their 
response to the idea was enthusiastic. 
Additional legwork included calls on 
other health care agencies with existing 
Birth Rooms and talks with infection 
control personnel about logisticso 
With a better idea of what was 
required, we decided to undertake a 
three to six month trial period. We chose 
the largest labor room to use as our 
alternate Birth Room in this period. 
where the patients and their birth 
partners would labor. deliver and 
recover, all in the same room. 
During the trial period, patients 
were selected according to the following 
. They must be self-selected: ie. 



. : irt 

they must expressly request this type of 
delivery and discuss alternatives with the 
. They must have completed a 
childbirth education course. 
. They must have had adequate 
prenatal care. 
. They must have a clear 
understanding of guidelines for initiating 
the move to the delivery room if 
necessary . 
. There must be no evidence of risk 
. Presentation must be vertex. 
. Patients must be prepared for 
natural childbirth. Epidural anesthesia 
would necessitate delivery in routine 
Guidelines detailing the philosophy, 
criteria and implementation were drafted 
and circulated to the nursing and medical 
staff: they specified that any patient 
requiring fetal monitoring, induction of 
labor or any other intervention, was to 
be delivered in a traditional delivery 
room. However, even with our 
guidelines, several conferences and 
mock set-ups, there were still problems 
to solve after the first few deliveries. 
There were questions regarding the 
sterile technique and extensive draping 
that are the norm in a traditional delivery 
room. We stressed the importance of 
handwashing and perineal preparation 
but it was decided that extensive draping 
of the patient was not necessary. The 
nurses continued to set up a sterile 
instrument table and gloves were worn 
by the physician. 



. . . 




Tha r.ftAltlAn Nit,."" 

Another problem was related to the 
definition of " high risk" and "low risk". 
Some physicians were using 
 (oxytocin) to augment labor 
and did not agæe that this disqualified 
the patient from delivery in the Birth 
Room. Some felt too that artificial 
rupture of membranes without the use of 
oxytocics was an acceptable means of 
induction for patients in this room, while 
others believed it disqualified the 
patient, based on the criteria outlined in 
the guidelines. 
The physicians had concerns about 
adequate space within the room should 
an emergency occur. This turned out to 
be a valid point as even with a minimum 
of essential equipment in the room, with 
father and a nurse and physician, it did 
prove to be cramped 0 

Back to the drawing board 
At the end of the trial period, we 
evaluated our interim Birth Room based 
on feedback received from both patients 
and professional staff members involved 
in the project. 
Records had been kept of each labor 
and delivery, and during the trial period, 
of the 15 patients who delivered in the 
Birth Room, all their infants had had 
apgars of8 to 10 at 5 minutes. 
One-minute apgars were 6 to 9 with the 
majority scoring 8. Where no episiotomy 
was performed, patients all had perineal 
tears of first or second degree. Nine 
patients were not able to deliver in the 
Birth Room; 6 of these were primiparas, 
3 multiparas. In all but one case the 


 ; 1 
::::::::::::::: 1 ' :: 
..i:.......::!!. I: 
mí n::'; I 









_ Þfc...l1.11111!! 31 

reason for the change was that the 
patient had opted for epidural anesthesia 
during the course oflabor. However, 
those who did deliver as planned were 
very pleased with the room. 
Feedback from the professionals 
revealed ongoing concerns about 
inadequate lighting, cramped space and 
relative distance ofresuscitation 
equipment. The most persistent problem 
was that some of the patients who had 
requested the service did not meet the 
department's criteria of "low risk" . 
They may have been acceptable at an 
earlier stage of pregnancy , but upon 
admission, were found to be at some 
degree of risk. These patients were then 
faced with disappointment and a 
situation which they did not fully 
comprehend. Those who required 
intervention during the course oflabor, 
such as intravenous therapy, fetal 
monitoring or Syntocinon augmentation, 
were frustrated by their inability to meet 
their personal goals. A few even delayed 
the decision to have prescribed clinical 
intervention because of their desire to 
deliver in the Birth Room. 
We decided that further study was 
required in order to achieve a more 
workable alternative. Increased 
flexibility and additional space were the 
most important features. After additional 
discussion, we decided to renovate a 
traditional delivery room. With some 
renovations and redecorating, we would 
be able to achieve all the objectives of 
the Birthing Room. We drafted plans, 
met with the maintenance department 
and planning board and finally received 
approval for renovations. 
The renovations were accomplished 
with relative ease: the ceiling was 
lowered, a washroom added and we 
decorated with some finishing touches of 
soft-colored wallpaper and sheer 
curtains. Equipment is srored behind a 
wallpapered screen, and built-in 
O.R.-style glass cupboards were draped 
with fabric. Oxygen, suction and 
anesthesia equipment were left in place. 
The labor-delivery bed is a convertible 
model made by Stryker* and has an 
adjustable back support, stirrups and 
other features that allow for flex ibility in 
the case of a more complex delivery. A 
sitting area in the room was provided for 
the mother and her coach with soft 
indirect lighting. 
We felt the advantages of the new 
room would be the increased space and 
the increased flexibility of use, both of 
which would allow for birth in a 
home-like atmosphere which allowed for 
emergency intervention if necessary. 
The criteria for the Birth Room 
patients were revised: as before, they 
emphasized the preference for 'natural' 
childbirth. New guidelines indicated that 

*available in Canada from Down 
Surgical Ltd., Toronto 

32 ......
.h 19811 

patients selected for the Birth Room 
must have a clear understanding of the 
indications for clinical intervention if it 
were needed; it was decided too that 
although presentation of the fetus should 
be vertex, breech presentations could be 
assessed on an individual basis. Patients 
do not have to be moved to another room 
for intervention, such as fetal 
At the time of writing, 51 patients 
have requested to deliver in the 
newly-renovated room, and 47 have been 
successful. (The four patients who could 
not were delivered by Cesarean section 
in our Section Room.) For all the 
patients, a family-oriented birth was 
achieved in a subdued and relaxed 

Organizing motherhood Once a patient 
and her partner have decided they wish 
to have their birth in this facility, they 
usually discuss their plans with their 
physiciano A meeting with the head nurse 
or clinical nurse specialist is then 
arranged to: 
. familiarize the couple with the 
. gain understanding ofthe couple's 
. inform couple of the hospital 
guidelines. to decrease discrepancy 
between their personal philosophies and 
that of the hospital 
. answer questions 
. inform the couple of alternatives in 
postpartum care such as mother-baby 
care, rooming-in, early discharge and 
home care. 
After getting acquainted. the patient 
and her partner are given a tour and a 
further opportunity to ask unanswered 
questions. The name of the patient. her 
E.D.C. and doctor's name are recorded 
in a log in the delivery room. This log is 
useful for information and for prediction 
of Birth Room use which is helpful to the 
staff; however, the Room is assigned on 
a first come, first served basis. 
A copy of the guidelines was sent to 
each physician practicing at our hospital 
and when the renovations were 
completed, additional publicity was 
undertaken in order to inform the public 
about the changes that had taken place. 
Notification wa... also sent to Childbirth 
Education Groups which aroused further 
interest and resulted in many calls about 
our serviceo 

The labor-delivery or Birth Room has 
proven to be a quiet and relaxing 
environment which enhances the 
experience of childbirth. 
The original plan was to meet the 
needs of a very small group of patients 
who wanted a 'natural' birth in a 
home-like atmosphere that provided the 
safety of the hospital; the result was that 
we are now serving the needs of a much 
larger group of patients. 

Ç'"_ I 


The attention devoted to the project 
and the discussions between physicians 
and nurses have increased professional 
awareness of the desires of many 
mothers and their partners to be actively 
involved and in fact to participate in the 
birth of their child. Now, we are able to 
give them increased flexibility and 
individualization of care inside the 
hospital environment. 
Having a baby today is safer than 
ever before. Today's obstetrical health 
care consumer has a far broader 
knowledge base than did mothers of the 
past: people want a shared birth 
experience and childbirth with dignity. 
Humanization of the hospital 
environment can help to enhance 
childbirth - one of the most beautiful 
and satisfying of all human experiences. 410 

I Carlson, B. Hospital "at home" 
delivery: a celebration, by B. Carlson 
and Philip E. Sumner. JOGN Nurs. 
5:2:21-27, Mar /Apro 1976. 
2 *Ferris, Carolyn. Alternative birth 
center at Mt. Zion Hospital. Birth Family 
J. 3:3, Fall 1976. 
3 Grad, Rae Krohn. Breaking ground 
fora birthing room. MCN 
A mer.J.Matern.Child Nurs. 4:4:245-249, 
Jul./Aug. 1979. 
4 Hardy, C.T. Hospital meets patient 
demand for "home-style" childbirth. 
Hospitals,JAHA 52:5:73-74,79-80, 
Mar.I, 1978. 
5 I nterprofessional Task Force on 
Health Care of Women and Children. 
Joint position statement on the 
del'elopment of family-centered 
maternity/newborn care in hospitals. 
Chicago, 1978. 

*Unable to verify in CNA Library 

Ellen L. Rosen,RN, BScN. MScN (ed.), 
receh'ed her basic education in Montreal 
as well as her baccalaureate from MctJiII 
Unil'ersity. She swdiedjor her master's 
degree at the Unh'ersity of Western 
Omario. and has been a general duty 
staff nurse and nursing instructor in 
sel'eral institutions. Currently, she is 
clinical nurse specialist in Obstetrics and 
GynecoloRY at the Victoria Hospital in 
London, Ontario. Rosen has had sereral 
other articles relatinR to obstetrics 
nursinl: and research published. 

An open letter to the nurses of Canada 

Jal/e MeldUe White 

I've been wondering how I could show 
my appreciation for your kind care 
during my recent hospitalization, 
especially for your help during the month 
before my baby was born and later, when 
I was re-admitted to help gain control 
over the grief resulting from his stillbirth. 
My talents run mostly in the 
direction of writing; that is why I've 
chosen to express my thanks this way. 
Whenever I have entered hospital 
because I have been depressed, at least 
one staff member has expressed the 
concern that "we aren't trained to deal 
with mental health patients." I 
sympathize and wish that I could make it 
easier for you. but at the same time. 
accept the fact that my coming into 
hospital makes life easier for me. 
The purpose of this letter is to 
reassure you that you do so many things 
right. I won't name names - I hope 
you'll recognize yourself - but I want all 
of you to feel, "Yes.I've done (could do) 
that. " 
About names...1 appreciate name 
tags and/or nurses who introduce 
themselves, "Rememberme,l'm ......... 
It is difficult to talk to someone whose 
name you don't know or. worse yet. feel 
guilty about forgetting. 
The decision to enter hospital 
always adds panic, guilt and a sense of 
failure to the other emotions I'm already 
finding impossible to handle. This is 
followed by relief when I actually reach 
my room and know "somehow it will be 
okay." A verbal reinforcement from the 
nurse to that effect is very encouraging at 
that moment. 
The admission fonn gives you the 
chance to find out what is really 
bothering me. I appreciate your allowing 
me to get to my room and calm down 
before trying to complete the form. Also, 
it's nice that you waited to come into my 
room until you had time to listen, instead 
of when you had to rush; this was better 
for both of us. In those first few hours, 
when all the feelings I'd bottled up so 
long had to be aired, the admission 
questions provided an opening. 
Another thing you do right is 
allowing me to talk to you: all those 
leading questions and that prompting 
really help. For example, "Did you want 
to be pregnant?" ..It.s okay to admit you 

don't feel able to care for a baby." And 
later, "How did you feel about losing the 
baby?" ..It is going to take awhile to get 
over it." 
You recognize that there is no easy 
answer but imply that I will be able to 
work things through. 
Most nurses understand the value of 
touch. You used it so effectively in so 
many ways: like catching my lower leg to 
gain my attention without startling me ifl 
were resting at thennometer time; like 
using both hands to take my pulse - the 
second to hold my fingers in a gentle 
"surrounding". When I was having a 
bad time, I appreciated the finn grasp of 
a hand helping me to hang on to reality. 
Back rubs feel so good when the 
tension builds up, especially when 
coupled with leading questions like, "Is 
something bothering you tonight?" or 
more generally, "How was your day?" 
The latter is a good question because 
sharing what I've figured out - the 
positives of a hospital stay - reinforced 
them so that I went to bed feeling I had 
grown in understanding that day. 
"Can I get you anything?" is I/ot an 
opening to talk. On the other hand, 
"We're here if you need anything. Just 
ring or stop us in the hall" is appropriate 
to both physical and mental needs. The 
pulling down of the call bell ann really 
reinforces those words. 
Once, right after visiting hours when 
she was usually rubbing backs. I stopped 
one nurse in the hall. "Have you 
time..." (I hated to ring the bell and tried 
hard not to.) She sat and listenedo Both 
of us realized the time limitation but as 
she left. she reassured me, "We all need 
someone to talk to sometimes." 
Comments like these are helpful: 
"You're not the only (or first) person 
who feels like that." "It's normal to 
react that way to this situation." "I've 
felt that myself." Such statements 
reassure me that: a) I'm not a "freak", 
and b) I'm still accepted despite the 
Of course , some nurses feel more 
comfortable listening than others, and 
naturally I looked forward to the shifts 
when these nurses were on duty. I 
especially appreciated the nurses who 
sat down saying (or implying by their 
question), "1 finally got a couple of 

minutes to visit with youo" The nurses 
who gave time when they had, or made 
time, really helped. Time - so often it 
boiled down to that when you seemed to 
be running up and down the halls with so 
much to do. In spite of that, I had to 
admire the personal attention you 
managed to give to each of your patients. 
The smiling, "You're lookin' good" as 
you passed my room or met me in the 
hall, the "how are you doing?" as you 
took blood pressure helped to prevent a 
sense of isolation. 
Once, I knew it was report time, but 
I also kney, I needed someone. A nurse 
answered my call and, as things began to 
get better for me, I apologized, "You 
have so much to do." She gave a helpful 
reply, "If my staying will help you regain 
control, I'll stay a little longer. " 
I could mention other things you did 
that were helpful... things like bringing 
me a cup of tea when I needed it, like 
letting me have my sewing machine in 
my room, like screening visitors. But the 
best support came from simply knowing 
that you were pulling for 
me...encouraging me to be well and 
happy again. 
.. ... help you regain control... " That 
was the phrase that you used. It made me 
realize why I was in hospital. that what I 
needed was a breathing space, a 
rethinking place, and you and your 
hospital gave me that. The responsibility 
for control is mine: it isn't something you 
or anyone else can give, so you have no 
reason to feel inadequate or guilty. 
You helped me when I needed help, 
in all the ways you could and now that 
I'm oULI want to say "thank you". I 
hope I won't be back for a long time but 
it is nice to know that you are there. 'V 

Iehille Whiteorigil/allv wrote this 
letter for the nurses at K indersley Union 
Hospital in Saskatchewan after being 
hospitalized there. Jane describes 
herself as afreelance writer. wife and 
mother of a youngster who just started 
school this year. She is actil'e in her 
community and her church. 

Tñ_ r,.n..lillln NlJr." 

March 1980 33 
.-...._. ftl 

Rose is expecting her second stillborn 
child after intrauterine death was 
confirmed five days ago. At 38 weeks 
gestation, she is now awaiting the 
induction of labor by the intrauterine 
saline method. Rose knows that her baby 
will not be born alive and speaks often of 
wanting to see the baby when it is born. 
She recalls the birth of her rust baby. also 
stillborn: "Actually no one ever asked me 
if I wanted to see the baby. I wished I had 
seen him. This time I must see the baby." 

Anna is delivered of a still born male 
infant; the cause of death appears to be 
torsion ofthe cord. She refuses to see the 
baby, but states that perhaps her husband 
will want to see the baby when he arrives. 
Anna's husband Paul declines despite 
being told that the baby is perfect in 
appearance. The next evening, following a 
discussion with the nurse and Pastoral 
Care worker, Anna and Paul ask ifthey 
may have the baby present with them in 
the chapel for a short memo. ial service. 
Unfortunately the baby is already under 
the care ofthe local funeral director, 
burial having been planned for the 
following day. 

Eva gives birth to a premature male infant 
of 22 weeks gestation. She is heavily 
sedated, having been brought to the 
hospital convulsing, with a diagnosis of 
severe eclampsia. She was unaware that 
within a few hours of birth, her baby was 
transferred by air ambulance to a center 
equipped to provide intensive care for the 
very premature infant. Within 48 hours, 
her baby dies. In the days that follow, Eva 
cries often, has long periods of silence and 
appears severely depressed. Her most 
frequent comment or conversation is 
centered around the fact that she has 
never seen her baby. "I'll never know 
what he looked like. Other people have 
seen my baby, but I'll never see him. I 
don't feel I've had a baby. I don't 
remember anything!" 

Sylvia and Charles have just lost their first 
child because of a spontaneous abortion at 
16 weeks gestation. Sylvia does not see the 
fetus, she lies passive and unresponsive 
following the abortion, sleeping most of 
the first 12 hours. Only when her husband 
is present does she show any signs of 

S. ".rch 1 QAO 


"The primary goal in support of the 
mourner is to be genuine and 
realistic about death, his loss and to 
help himface the psychological 
present, whateverit is."l 
Sheila Parrish 


 t , 
j . .. . 
.. . 
" .4 ! 

All of these women have something in 
common, they are grieving the loss of 
their babies through stillbirth or early 
neonatal death, a situation which is 
compounded by the inherent nature of 
the mother-baby relationship. How can 
nurses help these bereaved parents to 
commence the process of "letting go" , 
an essential phase of grief work? 
The specific circumstances 
surrounding perinatal death warrant 
special consideration in the management 
of grief. By considering the significance 
of visual and tactile experience for the 
parents and the stillborn infant, and 
secondly the value of participatory 
inclusion of the parents in a memorial 
service that places their loss in a spiritual 
and religious comext, I believe bereaved 
parents may be assisted to face the 
reality of death and move towards 
resolution of their grief. 
As health professionals, we have 
become increasingly aware of the need to 
become more knowledgeable about the 
needs of the dying and the bereaved, 
however, death is not a frequem 
experience in the obstetrical unit. 
Shorter hospitalization and earlier 
discharge of the postpartum patient into 
the community, where other support 
systems take over, means that the 
obstetrical nurse seldom sees the 
resolution of the grief process in the 
bereaved parents following stillbirth or 

The C.nadlan Nur______ 












early neonatal death 0 Hopefully 1 
nurses' intervention at the time c 
crisis will result in the healthiest 
adjustment for all concerned. 
Research into the long tenn etlects 
of grief management has revealed that 
many people become sick, either 
physically or emotionally following the 
death of a loved person. 2 The death of an 
infant may have a permanent effect on 
the parents, as they internalize their 
feelings of helplessness, acting them out 
in their social life and marriage, with a 
subsequent increase in marital 
problems. 3 Studies of adolescent 
pregnancies have shown that 
"Adolescents who do not fully address 
the process of mourning, after abortion, 
miscarriage or infant loss, may face a 
greater risk of subsequent pregnancy."4 
Grief is a complex emotion that 
varies from one individual to another. 
Each person has his or her own unique 
style of grieving; the existing skills for 
coping with death are detennined in part 
by cultural attitudes and personal beliefs 
and the individual circumstances 
surrounding the loss. The mother and 
father may face the same loss but be at 
differem stages of grieving. This problem 
ofgriefresolvement is compounded in 
the case of the stillborn or early neonatal 
death, by the special nature of the 
relationship between mother and baby 
existent at every birth. 

New dimensions in assisting bereaved parents 

All pregnant women experience 
some fear that the baby will not be 
normal and may die, nevertheless, the 
infant is usually anticipated with joy . 
Both parents develop a fantasy image of 
a peJfect infant that may not be at all like 
the infant they eventually have. The 
mother moves through the normal 
phases of the pregnancy, acknowledging 
the fetus within her as real, then a feeling 
that she and the baby are one and finally 
accepting the reality of the baby as a 
separate being. However a state of 
anxiety normally exists at the end of the 
pregnancy when acceptance of the 
reality of the baby as a separate being 
and a future love object cannot 
completely overcome an inner 
unwillingness to give up this gratifying 
union of mother and baby as one. This is 
usually resolved after the birth when the 
love relationship is established." 
During the pregnancy it is difficult 
for parents to picture their baby in an 
objective form; consequently after the 
birth there is an intense need to examine 
the new baby directly to give him an 
identity. Doing this allows the parents to 
organize their concepts and feelings of 
the baby in relation to themselves and 
their behaviors or responses to the 
child." At birth, the mother who is able to 
hold, see and hear her baby quickJy 
accepts the reality of the baby as a 
separate individual. Complete 
identification, however, may take 
several hours, days or even weeks. 
Despite the happiness and excitement 
following the birth of the healthy baby, 
there is already a form of grief in 
process. The normal childbirth 
experience has been described as one in 
which bereavement, often not 
acknowledged, exists. 
In the case of a stillborn or neonatal 
death, the mother must face the reality of 
the death plus the fact that the outcome 
of the pregnancy was not successful. She 
will need to break the ties to the lost 
child, but she will also need to have first 
identified and accepted the child as herso 
Current childbirth practice places heavy 
emphasis on the need for the mother and 
baby to be physically close immediately 
after the birth. Should not the same 
effort be made in the case of the stillborn 
infant? Consider also the premature or 
sick infant who is whisked away to 
receive appropriate care and may die 
before the mother has a chance to claim 
her living child. 

In the hushed, uncomfortable 
atmosphere that follows the stillbirth. the 
delivery room nurse does her best to 
support the mother and, if he is present, 
the father but, in my experience, the 
subject of seeing the baby or holding the 
baby is not often broached, especially if 
the infant is disfigured or abnormal. The 
parent has usually been the one to ask to 
see the baby and, in retrospect, I feel 
that not too many did! How many would 
have chosen not to experience their dead 
baby will never be known, of course, but 
on the other hand, how many more 
would have seen or held the baby had 
someone suggested to the parents that 
this was an acceptable and normal thing 
to want to do? Naturally, not all 
bereaved persons want visual or tactile 
experience of the deceased, and the 
wishes of each individual must be 
respected. As well. the bereaved person 
may be so overwrought that he or she is 
unable to comprehend the situation or 
even listen to the discussion in order to 
make a decision. 

Viewing the body 
What is to be gained by seeing the body? 
Two important purposes served in the 
custom of viewing are realization and 
recall. 'The bereaved are more aware of 
the death in that seeing is believing, and 
an image is provided for recall of the 
deceased. "The image becomes the 
working basis from which reorganization 
of life takes place. When the image is not 
clear and the deceased is put out of the 
mind. the mourner may begin to create 
illusory pictures that serve ill as a 
foundation for rebuilding life 0 ". 
Where there is no proof of death, 
denial is apt to be prolonged. It is not 
difficult to understand why the mourners 
who have the most difficulty resolving 
their grief are those who never get to see 
the body because of drowning, air 
tragedy or other situations in which the 
body is never found. I n a study of war 
widows in Israel, the lack of presence of 
the body of the deceased delayed even 
the start of the bereavement process for 
many of the wives. Death became a 
reality only after some physical evidence 
or encounter occurred such as seeing the 
grave or receiving something that 
belonged to the deceased." Often persons 
who are suffering iJlness as a result of 
unwisely managed grief cannot 
remember very well the image of the 
deceased. 'The recognition of death is a 
necessity for continuing life, and grief is 
a necessary and unavoidable process in 
normative psychological functioning. "10 

The Cenedlen Nur.. 

Because of her toxic condition, Eva 
was under heavy sedation and did not 
become alert ;n time to see her infant 
before he was transported by air 
ambulance to a larger center for intensive 
care. The baby died two days later. Eva's 
constant cry of anguish was that" I never 
even saw my baby. If only I could have 
seen him once." I attempted to give Eva 
some visual idea of what her baby had 
looked like, in terms of development. By 
showing her pictures of a 24-week-old 
fetus, she was able to understand some of 
the problems of prematurity. She smiled 
for awhile and was grateful, but she 
wanted to see some resemblance of her 
family in the baby. I was acutely aware of 
the importance of identification for Eva 
and wished that someone had taken time 
to take a photograph of her baby before 
the transfer. As far as Eva was concerned, 
it was as if she had "never had the baby" . 
Physical symptoms that could possibly be 
related to unresolved grief caused Eva to 
be readmitted to hospital twice in the 
postpartum period and currently she is 
under psychiatric follow-up. 

Viewing the body is never pleasant 
and sometimes we think it is kinder to 
spare the bereaved this additional agony 
As I look back. I realize it has often been 
the first reaction of the father of the baby 
to say he doesn't want his wife to see the 
baby, saying "she will be more upset" or 
"she can't take it". Some nurses and 
doctors operate from their own feelings, 
unconsciously not wanting to be part of 
the discomfort involved and accept the 
parents' initial reaction too readily. A 
parallel can be drawn in the case of those 
who advise the single parent giving up 
her baby for adoption not to see the 
baby, thinking that it will be less painful. 
They do not realize "that the choice is 
not between pain and no pain; but 
between wisely managed suffering and 
unwisely managed suffering"... In a 
study of unwed teenage mothers, those 
mothers who saw their babies were able 
to work through their feelings more 
quickly and had fewer long term adverse 
effects whereas women who did not see 
their babies developed disturbed 
emotional patterns of behavior and 
tended to withdraw from human 
relations. Denying the reality of the basic 
relationship between mother and child, 
prevented the normal process of 
mourning from being employed. 12 

Merch 1lIIIO 35 

At an appropriate moment and as 
soon as possible the nurse should make 
the parents aware of the opportunity to 
hold, see or touch the stillborn baby if 
they wish. In the last three years, I have 
witnessed 37 stillbirths. The initial 
reaction of 25 of these mothers was not 
to see the baby, but, following gentle 
explanation of the value of seeing the 
baby and allowing the parents some time 
alone to discuss how they felt, 
approximately 20 changed their minds. 
None have regretted the decision, the 
usual comments being, "I was afraid to 
look and it was hard, but I'm so glad I 
did." ". feel that he was really mine." "I 
would have resented it later if my 
husband had seen the baby and I 
hadn't. " 
If the mother is under sedation and 
unable to participatte, or if she changes 
her mind after the baby has been 
transferred to the funeral home, it is 
important that she receive concrete 
information about her baby, including 
sex. weight. coloring and so on. Positive 
comments concerning the formation of 
nails, hair and peaceful expression are 
especially needed in the case of a 
deformed baby. In addition most 
mothers treasure receiving the name 
bracelet and an information card 
normally placed on the crib. FolloWIng 
baptism of the baby, a certificate of 
baptism should be offered to the parents: 
this comforts them in their spiritual need, 
helps the mother unable to see her baby 
accept the reality of birth and the finality 
of death and also places the baby in the 
context of a church community. 
Whenever possible, the parents 
must be prepared to see the body. 
Asking them if they have ever seen a 
dead body before and discussing 
expectations, opens up opportunities to 
explain about skin change, maceration, 
rigidity and coldness. In addition, the 
nurse must recognize and face her own 
feelings since how the nurse perceives 
the baby will affect the parents' 
response. Wrapping the baby in a warm 
blanket, holding the baby in a caring way 
close to her body, the nurse conveys to 
the parents that the baby is acceptable to 
her, especially important if the baby is 
disfigured or abnormal; and in turn the 
parents may be influenced in their feeling 
toward the baby as desirable to hold. 

Rose had repeatedly informed the 
nursing staff that regardless of how the 
baby looked, she wanted to see her child. 
She had been denied seeing her fU'st 
stillborn at another hospital, two years 
previously. Following the delivery of a 
macerated stillborn female infant, Rose 
received the routine post delivery care and 
was transferred to the recovery room to 
await the arrival of her husband whom 
she felt would also want to see the baby. 
She did not wait however. About 15 
minutes later she called me, said she was 
ready to see the baby and was it possible to 
have her mother present. Rose was 
prepared for what she was to see as we 
had talked about this on several occasions 
during the days before delivery. 
When I brought the baby to her, Rose 
sat upright in bed but kept her arms and 
hands close to her body. I unwrapped the 
blanket to expose the body which was 
moderately macerated and misshapen. 
Although the skin was peeling and some 
fluid escaping, I had deliberately left my 
gloves off not wanting to convey anything 
to Rose that might suggest I found the 
baby undesirable. I lifted the bab)"'s 
hands and feet and we counted the toes 
and fmgers together. Rose asked to see the 
baby's back. Since the fetal skull had 
collapsed, the baby had very little 
resemblance to the baby once fantasized. 
Rose wistfully remarked that she had 
hoped to see some family resemblance. . 
gently encased the baby's head in my 
hands, molding as much as possible to 
create some facial symmetry. Rose 
suddenly responded with a cry of delight, 
"Yes, there is a resemblance. She looks 
like John! Oh yes, I can tell this is our 
baby!" Then she held her hands out and 
asked if she could touch the baby in the 
same way. Gently she explored the baby 
with her fingertips. Finally she wrapped 
the baby in the blanket, held her close for 
a moment and then with a peaceful look 
said, "Thank you nurse, this has meant so 
much to me. You see, I never saw my fU'st 
baby. " 

Rose has since corresponded with 
me. It appears that she has completed 
her grief work. Hopefully this experience 
has helped herto resolve her grieffor the 
first child. Rose, because of her prior 
knowledge of the intrauterine death. had 
gone through some anticipatory grief, 
and some of the tasks of mourning may 
already have been completed prior to 
delivery . 

The C.nllCll.n Nur.. 

Anticipatory grief can also mean 
that the relatives are prepared. The nurse 
needs to be sensitive to the family that 
has become so well prepared that its 
members might not be as supportive of 
the mother at the time of delivery as 
would be expected. Sometimes the 
mother in an attempt to deny reality may 
stop investing in a relationship with the 
baby prior to birth, feeling that she has 
suffered enough and will have nothing to 
do with the baby. She may hlame the 
baby for the stress and painful 
procedures and then feel guilty about the 
resentment. Unless she understands that 
this is a normal reaction, her grieving 
may be impeded. 
Touching and looking "symbolically 
helps to close the mystic gap between life 
and death more realistically, although at 
times more harshly, if the baby is 
disfigured. ""'This is especially true if 
the parents are unable to view the baby 
until after an autopsy has taken place. 
Preparation in this instance is extremely 
Mothers or parents of the 
spontaneously aborted fetus may also 
have a need to view the fetus. The need 
will obviously be dependent on the 
length of the pregnancy and the usual 
variables. I realize there may be a degree 
of impracticality in my suggestion; my 
gynecological nursing colleagues inform 
me that in the majority of abortions the 
mothers show very little curiosity or any 
interest in seeing the fetus. I suspect that 
for some mothers, further exploration as 
to their feelings would have revealed a 
need for imagery. 

Sylvia and Charles were parents of a 
16 week fetus delivered in the obstetrical 
unit following which Sylvia appeared to be 
coping reasonably well. However, 24 
hours after the abortion Charles asked to 
speak to me. He said that he and his wife 
were really distressed about the loss of the 
baby and he wanted to know how he could 
help his wife who was having great 
difficulty talking about the situation. I 
spent some time with both ofthem. Sylvia 
eventually broke down, saying, "I've lost 
a baby - just because it was only a few 
weeks developed doesn't mean it wasn't a 
baby. It doesn't even get buried! I think of 
him as my baby, I've even given him a 
name - after his grandfather. " I asked 
Sylvia and Charles if it would be helpful 
for them to have a brief memorial service 
for the baby. They expressed interest in 
this, and following a visit by the chaplain 
ofthe hospital, the four of us attended a 
service in the hospital chapel prior to 
Sylvia's discharge. Both parents 
expressed relief and gratitude for this 
opportunity; their grief work was 
facilitated by this acknowledgement of 
Bohby as an individual human being. 

Placing loss within a spiritual and 
religious context 
Placing the loss of the baby within a 
spiritual and religious context in keeping 
with the individual beliefs of the parents 
also facilitates the grieving processo It is 
well known that supportive interpersonal 
interaction takes place during religious 
mourning practices and the funeral itself 
is another means of assisting the 
bereaved to let go. The funeral meets 
often very personal needs and at the 
same time may represent the religious 
beliefs of the deceased and the family. 
"The funeral is not only a declaration of 
a death that has occurred, but it is also a 
testimony of a life that has been lived. "14 
In my experience, however, some 
bereaved mothers have experienced 
further distress by not being able to be 
present at a burial service for the baby. 

Angela, who gave birth to a male 
child that lived for only a few minutes, 
was asleep during the birth. She was 
severely hypertensive and under sedation 
and had very little recall ofthe events 
surrounding the delivery. Two days later 
she asked to be discharged from the 
hospital in order to attend a burial service 
for her baby; in fact, she threatened to 
discharge herself if not given permission. 
Despite the persistent hypertension, the 
physician understanding Angela's need, 
temporarily released her from the 
hospital. Angela understood the risk she 
was taking, but for her the need to face the 
reality oflosing her baby took priority 
over her own health. In her own way, 
however, Angela was looking after her 

The memorial service 
Evaluating the effectiveness ofthe 
current support system for bereaved 
parents within my hospital led to my 
sharing some concerns with the Director 
of Pastoral Care. We reviewed local 
funeral practices, became more aware of 
the flexibility of services, learned about 
alternatives for those for whom burial of 
the baby meant economic hardship, and 
became more organized in our plan to 
help parents with special needs; for 
example, we advised parents who 
wished to bury the baby without the 
services of the undertaker, directed 
parents in transportation of the body 
according to provincial requirements, 
and so on. We also offer parents and 
other family, including siblings, an 
opportunity to participate in a memorial 
service held in the hospital chapel. 

Awareness of the philosophy of life 
held by the parents is essential as their 
attitude toward death will follow closely 
their feelings about life. In our hospital 
the nurses and Pastoral Care worker 
share information in the interest of 
planning the best approach for the 
bereaved. The parents are made aware of 
the availability of a memorial service and 
in no way are pressured to make a 
decision at first conversation. The 
service may be conducted by the 
family's own minister or priest or by the 
hospital Chaplain or a Sister from the 
Pastoral Care Department. A memorial 
service differs from a funeral service in 
that it is acknowledgement after death, 
without the body present. Not all parents 
choose a memorial service but those who 
have are unanimous in their comments 
that the service is helpful and had special 
meaning for them. One family asked 
instead that the nurse pray with them at 
the bedside. Regardless of the location or 
format of the service, some positi ve 
things can come about for the mourners 
and staff attending the memorial service. 
The service itself can be of 
therapeutic value as it recognizes the 
grief of the parents and helps them to 
experience the grief together and in the 
presence of other supporti ve. 
individuals. It can help to prevent 
pathological denial and later difficulties 
by helping the parents to openly face the 
reality of the loss. It can be a significant 
point in the letting go process. Not only 
is the mother able to be present, but she 
is able to receive physical support from 
the nurse if she becomes weak or ill. 
There is no cost factor involved for the 
parents. In addition the memorial service 
provides an opportunity for the staff to 
share in more than just physical and 
emotional care; it helps them to place 
their own sense of loss in a religious and 
spiritual context. 
As inner acceptance is considered a 
very positive and constructive stage in 
the process of mourning, IS the memorial 
service can be an effective means by 
which the bereaved are able to face the 
reality of death, accept it and then move 
on into resolution of grief. The service 
offers an opportunity for the family to be 
sustained through the expression of their 
religious faith and an acceptable setting 
within which they can let out their 
feelings. Finally, it provides a means by 
which the hospital staff can convey to 
the family their belief in the worth and 
dignity of the human person and indeed a 
reflection of the value we place on life 
itself. OW 

1 *Murphy,G. The meaning of 
death. (In Morano, Nicholas. Blessed 
are the mourners. The Way 16:2:læ, 
Apr. 1976). 

The Canadian Nur.. 

2 *Lindman, Erich, Grief and grief 
management - some reflections. 
J.Pastoral Care 30:3, Sep. 1976. 
3 Kavanaugh, Robert E. Children's 
special need,,? (In Dealing with death 
and dying. 2d ed. Jenkintown, Pa., 
Intermed Communications, 1976) 
4 * Horowitz, Nancy Heller. 
Adolescent mourning reactions to infant 
and fetallosso Social Casework Nov. 
5 Rubin, Reva. Binding-in in the post 
panum period. Matern.Child NursoJ. 
6:2:70, Summer 1977. 
6 Ibid., p.68. 
7 Raether, Howard C. The funeral 
and the funeral director, by Howard C. 
Raether and Robert C. Slater. (In 
Grollman, Earl. Concerning death: a 
practical guide for the living. Boston, 
Beacon Press, 1974). 
8 *Jackson. EdgarN.Fortheliving. 
Des Moines, Iowa, Channel Press, 1963. 
9 *Golan, Naomi. Wife to widow to 
woman. Social Work Sep. 1975. 
to *Rakoff, Vivian. Quote. (In 
Gerson, Gary. The psychology of grief 
and mourning in Judaism. Jo Religion 
Health 16:4:264, Oct. 1977). 
II Jackson, EdgarN. When 
someone dies. Philadelphia, Pocket 
Counsel Books, 1973. p.12. 
12 Ibid. 
13 Glaser, BarneyG. Timefordying, 
by BarneyG. Glaser and Anselm L. 
Strauss. Chicago, Aldine Pub., 1968. 

Grollman, op.cit.. p.I90. 

*Unable to verify in CNA Library 

Sheila Parrish,RN, a graduate of The 
General Hospital, Nottingham, 
England, worked as a hospital and 
district midwife in England before 
coming to Canada. Pre.fently, she is 
Head Nurse of the Obstetrical Unit, St. 
Joseph's Hospital, North Bay, Ontario 
and is working towards a Bachelor's 
Degree in Sociology. 

Acknowledgement: Thanks are expressed 
to Revo James McHugh, C.R., Director 
of Pastoral Care, St. Joseph's General 
Hospital,for his valuable help and 
guidance; to the Sisters of the Pastoral 
Care Department and to the nursing 
staff of the Obstetrical Unit. 


Uar,..h t GAllI 

o/d ....nu
. who." moth" TIY'la en Duties 
tongue is Italian, was upset: her .. II The volunteers taking part in this 
two-day-old son was very . program are expected to: 

%; :i




ne er l! j eDCe · r:


seemed so busy and her English 
 feeding practices by assisting 
was not very good. She wished and counseling them about 
she having so much trouble? Was the re an problems as they occur in hospital. 
something wrong? Maybe she didn't . sell articles such as nursing bras, 
have any mil/... and the baby was nighties and books on breastfeeding and 
starving? child care (Maturnisales. we call them). 
Sylvia Segal Articles and books for sale have been 
suggested by the nursing and medical 
staff. The exchange provides a good 
opportunity for teaching and there is 
more stress on teaching than on making a 
· assist nurses with discharges by 
helping the patients gather their 
belongings together and escort the family 
to the hospital door. 

33-year-old Mrs. P. didn't know how she 
was going to cope; she felt so ridiculous 
asking the same questions over and over 
again. The nurses reassured her this was 
normal and she shouldn't worry about it, 
hut how could she be such a 
scatterbrain? Why was she having so 
much trouble? Breastfeeding seemed so 
natural when they discussed it in 
prenatal classes, and she had read the 
recommended books. But now tears 
rolledfrom her eyes as she gazed at her 
hard, aching breasts and >>'atched her 
screilming three-day-old daughter trying 
to grasp the nipple. She winced with 
pain as the baby finally got hold, and 
thought, "Is it really worth it?" 

Mrs. J. was very anxious: she had lost 
two prel'ious babies and now her 
premature daughter, Andrea, seemed so 
tiny and fragile. The doctor said Andrea 
was strong and healthy but Mrs. J. 
wished the nurses could stay with her 
until she finished her bottle. The nurse 
told her to burp the baby after every half 
ounce, but it was difficult to tell when 
half an ounce had gone. Andrea always 
seemed to gulp her bottle so quickly and 
then she seemed to spit most of it back 
up. Would she ever be alright? 

Helping new mothers sort out their 
questions and problems is easier when 
you've been there yourself. That's one 
reason why, in our hospital, we have 
come to depend on specially trained 
volunteers to bolster the support that 
nurses on the obstetrical unit are able to 
provide to patients. 
York Finch General Hospital (300 
beds, 38 OB) in Toronto is like hospitals 
everywhere these days - a victim of 
increased consumer demands and 
spiralling costs. Staff freezes and 
cutbacks are making it increasingly 
difficult for nurses to devote as much 
time as they would like to patient 

38 March 1980 

, . 



\ '-


The charge nurse takes time out to 
discuss patient problems with a 

It was three years ago that I 
approached the director of volunteer 
services, Elsa Ann Lee, about the 
possibility of initiating a volunteer 
program for new mothers. As 
coordinator of obstetrics, I wished to 
maintain our unit's family-centered 
approach with its relaxed and flexible 
schedule that made demand feeding 
possible. We both could see the 
advantages of an in-hospital, one-to-one 
counseling program on infant feeding 
practices by trained volunteers. 
As a pilot project, we trained one 
volunteer who introduced the service to 
some of the mothers in hospital at the 
time. The program was an overnight 
success: soon we had volunteers · 
working on the OB Unit every weekday, 
responding to the needs and concerns of 
our new mothers. 

The CanllCllan Nur.e 

Volunteers are interviewed and selected 
by the Director of Volunteer Services. A 
subjective evaluation by the interviewer 
is made regarding attitude toward 
breastfeeding, modem feeding practices 
and childrearing. Successful candidates 
are expected to have a positive, 
"family-centered" , outlook; other 
characteristics we look for are those of 
any volunteer: a caring attitude and a 
friendly, outgoing personality. Facility in 
a second language has also proved a 
definite asset at York Finch which 
serves a multi-cultural population. 

Before being allowed to counsel on her 
own, each volunteer has to complete a 
training period which includes the 
1. the concept of family-centered care 
2. the philosophy of the obstetrical unit 
3. hand washing technique and general 
4. infection control theory and practices 
5. process oflactation 
6. common breastfeeding problems 
encountered in hospital and how to deal 
with them 
70 common bottle feeding problems 
encountered in hospital and how to deal 
with them 
8. discharge procedure - the limitations 
of the volunteer. 
Each volunteer must also complete 
"ix on-the-job training sessions with a 
trained volunteer. At the end of the 
training period, each volunteer 
completes a written take-home 
examination, and is evaluated by her 
trainer and by the programs's nursing 

On the job 
Volunteers wear a rose-color dress 
uniform while on duty: these uniforms, 
which can be purchased or rented, must 
be laundered or dry cleaned before each 
day's shift begins. A lab coat, supplied 
by the Volunteer Department, is worn 
over the unifonn whenever the volunteer 
is off the unit. 
All volunteers are required to have 
an annual chest x-ray orTB skin test 
provided by the hospital. 
Each volunteer is assigned to a 
specific shift - 9:00 a.m. to II :30 a.m. 
or 1:00 p.m. to 3:00 p.m. - and is 
responsible for notifying the unit and the 
Volunteer Department if she is unable to 
report for her shift. Replacements are 
obtained by either the volunteer who is 
unable to work or the program convenor. 
Not surprisingly, the Summer months 
are the most difficult to ensure full 
As the program evolved, a daily 
routine was developed by the volunteers 
and hospital staff: these routines are 
checked annually and revisions made as 
needed. Good communication is the key 
to the success of the program and this 
aspect of the work is stressed in all our 
acti vities. 
Volunteers check with the team 
control center for any "problem notes" 
left by the general nursing staff in an 
envelope provided for this purpose. The 
charge nurse of Postpartum or Nursery 
Departments is then contacted (or Team 
Leaders in their absence) for a report on 
any other problems. The first visits of the 
shift are with mothers reporting 
problems or mothers requesting supplies 
from Maturnisales. If time permits, the 
volunteer then systematically visits as 
many patients as possible, telling them 
about the service, asking if there were 
any problems or questions, and showing 
them Maturnisale supplies. Notes are left 
for the afternoon or following day 
volunteer to ensure further follow-up of 
problems and to identify how many 
patients were visited that shift. 

Ongoing training 
Every six or eight weeks we schedule 
meetings on topics related to 
breastfeeding and modem infant feeding 
and care practices. A volunteer must 
attend two out of three of these sessions 
to remain active on the service. 
Listening, communication skill
consistency and recognizing the 
limitations of the volunteer role are 
stressed during these discussions and 
ongoing training. Volunteers were 
actively involved in developing the 
original program and continue to have 
say in its direction. 








. ' 






A volunteer from Maturnisales helps a patient choose a nursing bra. 

Ifan active volunteer is off the 
service for three months or longer she 
must again attend on-the-job training 
sessions and be re-evaluated before 
counseling on her own again. 

For the patients, the service means an 
interested, caring, empathetic 
"experienced mother" who has that 
extra time to listen and help. 
For the nurses, the service provides 
a well-infonned co-worker who can be 
trusted to give much needed support and 
accurate information to an anxious 
For the volunteer, the service 
provides the opportunity to offer help, to 
keep up-to-date on modem infant feeding 
practices and care, and also to develop 
her problem-solving and counseling 
skills. The service has also helped to 
create a positive encouraging 
atmosphere toward breastfeeding which 
is very evident on the unit: much of the 
volunteer's time is taken counseling and 
supporting the breastfeeding mother. 
Obstetrical units, I'm sure, are not 
the only areas of the hospital where 
volunteers could provide services. Each 
hospital needs to examine its own 
situation and needs. Our program owes 
much of its success to the enthusiasm of 
its volunteers whose interest, in turn, is 
maintained by keeping them active in 
their service. Programs such as ours 
could not exist without the support and 
guidance of the nursing staff. Someone 
on the unit must take the interest and the 
time to motivate the volunteers and keep 
them up-to-date in their theory and 
practice knowledge. 

Ttw Canadian Nur_ 

Today there is a good deal of 
consumer pressure for greater flexibility 
on obstetrical units. I hope that our 
example will encourage other hospitals 
to open their doors to volunteers, since 
these programs provide an excellent 
opportunity for hospitals to bring a bit of 
the "home touch" atmosphere to their 
environment. .., 

Author S
hia Segalgradltatedfrom the 
Uni,'ersity of Alberta in Edmonton, 
Alberta. in 1964. She has experience in 
armed sen'ice, public health, teaching, 
prenatal education and general duty 
nltrsing. Much of her tead,inK and 
practical experience has been in the field 
of obstetrics 0 
Atthe time the program she 
describes in this article was set up, she 
was Coordinator of Obstetrics and 
Gynecology at Yor!"FinchGeneral 
Hospital in Toronto. Segal is married 
and has two boys. She retiredfrom 
full-time duty in the summer of 1978 but 
continues to proride training and 
guidance for the volunteers at York 

Acknowledgement: The author wishes to 
acknowledge the contribution of Elsa 
Ann Lee, Sheila McKewen, Will.\' Wallis, 
Pat Thorburn and HelenFron
ak, whos
enthusiasm and support of the program 
since its conception motÎl'ated her to 
write the article. 

....rl"h t aan "I.G 

A postpartum progam 
that really works 
Help for new mothers is as near as the 
phone in this small community 
in north central B.C. 

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Kathleen Freeman 


How could six community nurses, each 
already as busy as the next with 
immunization schedules, pre-school 
health assessments, long term care for 
senior citizens and home care for 
convalescents, possibly take on close to 
500 new family units annually without 
seriously compromising the care they 
were expected to give? 
What is the most efficient and 
effective way of making sure that new 
mothers get the help they need when 
they need it - the crucial days and 
weeks immediately following delivery? 
How can postnatal problems be 
spotted and solved before they reach 
crisis proportions? 
How can nurses serving a scattered 
rural community keep non-productive 
"travel time" to a minimum? 
These were some of the questions 
that our office of the regional health unit 
was faced with five years ago. Our 
search for the answers, which continues 
to this day, took into account two major 

. our unique demographic situation as 
a small town (pop. 23,000, including the 
surrounding area) about half way up the 
BCR railway line that links Vancouver to 
Fort Nelson, B.C. 
. our philosophy and objectives 
which might be summed up by the belief 
that knowledge, to be preventive, must 
be available before, or at least at the time 
that it is needed. 

The problem 
Before we could begin to find answers to 
the questions that confronted us, we had 
to define the dimensions of our problem. 
As a preliminary step, we undertook the 
development of a profile of community 
needs and trends based on demographic 
data that we assembled ourselves. At 
first, the only statistics we had were 
those relating to the number of births and 
school entrances. Then, from the census, 
we obtained more infonnation about the 
various age groups in the area; a survey 
by the provincial department of 
economics on local industry gave us 
information about occupational 
characteristics. Once this method of 
planning was used successfully, each 
application to additional programs 
became easier. Through yearly updating 
and the addition of demographic data, as 
it became available, we soon had a fairly 
comprehensive profile of community 
needs and trends. 
When we looked at this profile, we 
saw a steady influx of young couples into 
Quesnel to work in local industry, 
balanced by a steady outflow of families 
after the wage-earner gained more 
experience and higher qualifications. 
During the time these young couples 
were living in Quesnel, they would begin 
lheir families; in the community there 
were about 450 births per year. This 
number could be expected to remain 
constant or even to rise slowly. If we 
continued our present system of home 
visits, this would mean at least 450 hours 
of contact time, plus 200 hours of travel 



time,just for initial home visits each 
year. Due to thl! high number of births 
and the system for referral. home visits 
were often made when the infants were 
three or four weeks old. after many 
crises had already passed. 

Our objectives 
In a rural area such as ours, where there 
is no routine physician follow-up until six 
weeks postpartum, the role of the 
community health nurse is very 
significant. Thinking about this role and 
our new program, we reiterated as a 
group some of our fundamental beliefs 
about the philosophy of community 
health nursing. We believe in prevention. 
We believe that people need a variety of 
types of support and that they are 
capable of choosing and using the type of 
support that best fits themselves as 
individuals. Also, a maximum amount of 
nursing time should be available to 
counsel high risk families. 


Keeping these considerations in 
mind, we drafted our objectives for the 
postnatal program as follows: 
. to have contact with every mother 
giving birth prior to discharge from 
hospital, and again one week after 
. to provide each mother with 
information regarding maternal and child 
care. enabling her to function effectively 
at home with a young infant. 
. to identify as early as possible any 
mothers and/or infants who are at risk of 
developing problems. 
. to use the most efficient and 
etTecti ve methods of meeting the needs 
of both high risk and "normal" mothers 
and infants. 
. to provide an ongoing, easil} 
utilized resource where information and 
group support are available to mothers as 
. to obtain feedback on the usefulness 
of the postnatal program through parental 
assessment and formal evaluation. 

The tools 
The postnatal program that we 
developed in response to these needs 
consisted offour distinct elements. 
These are, in the order in which we make 
them available to most families: 
I. In-hospital classes 
2. A telephone check six to ten days 
3. New infant classes at the Health Unit 
4. Home visits 

1.1 n-hospital classes - The first line of 
support for the mother is knowledge of a 
newborn's needs and behavior and of the 
maternal changes postnatally 0 To 
provide this knowledge to every mother 
in the most efficient method, we 
arranged with the local hospital to 
conduct classes on the maternity floor 
twice a week just before lunch. This time 
was made available through the 






cooperation ofOB nursing staff and the 
physio department which reduced daily 
postpartum exercises to three times a 
week to accommodate our classes. 
Studies have shown that maximum 
learning takes place at the time of crisis 
and need and, for this reason, the 
hospital stay provides a highly 
appropriate learning situation. 
Postpartum mothers can be gathered 
together as a group using a ward or 
lounge as meeting place. The CHoN. 
uses a combination of discussion and 
didactic instruction to present 
information concerning the care of a 
newborn baby and the needs of a mother 
after discharge. The group setting makes 
it easy for mothers to ask questions. 
share concerns and obtain support from 
one another. Further reinforcement of 
learning takes place if mothers discuss 
class content afterwards. 
Prior to the classes, mothers 
complete cards providing us with 
information on the family, prenatal class 
attendance and method offeeding. 
Problems that arose during the 
pregnancy or factors that might indicate 
risk are filled in by the CHoN. before 
she returns the cards to the health unit. 
These cards help our nursing staff plan 
the appropriate follow-up contact with 
the mother: clerical staff use them to 
prepare agency records, and they are 
used as part of the program evaluation. 
During the class, mothers are given a 
folder containing a collection of 
pamphlets that they can read now and 
keep for future reference, (see Box). 



The staff of the Qursnel Branch of tbe Cariboo Health Unit rleft to right): author Kay 
Freeman. Marilyn Hurrell. Susan Brown, Terry Stevenson, MaryGradnitzerandEileen 
Kosior. Former staffer, Debra Little, who was since mo
'ed to Kelowna, is missing 
from the photo. 

Resource material 
postpartum classes 

1. Planned Parenthood Federation of Canada. 
Birth control that worb. 
2. British Columbia. Ministry of Health. Your 
pubUc bealth services. 
3. International Childbirth Education Assoc. 
Instructions for nunlnll your "by. 
4. Johnson & Johnson. Heths and balMes. 
S. British Columbia. Ministry of Health. 
Common variations In the newborn. CHU * 16. 
6. British Columbia. Ministry of Health. 
Infant feedInI. 
7. British Columbia. Ministry of Health. 
Blender baby foods. CH U * 16. 
8. G.R. Baker Memorial Hospital. Diet for 
nUnInll mothers. 
9. Infant food guide. B.C. Diet Manual 1976. 

During the classes, we actively 
encourage aU the mothers to call the 
health unit if they have questions or 
problems after discharge, and invite 
them also to attend our new infant 
classes at the health unit. These 
postpartum classes take approximately 
two hours of nursing time a week. 

2. Telephone check - The majority of 
mothers in Quesnel are discharged on the 
fourth or fifth day postpartum. Between 
the sixth and tenth day, we make a 
"phone visit" to all mothers with 
telephones during which we enquire as to 
how the mother and baby are doing. 
Initially, we use open-ended questions. 
If the mother's responses remain 
general, we proceed to more specific 
questions such as condition of the cord, 
feeding and sleeping patterns and the 
amount of rest the mother is obtaining. 
This allows us to counsel appropriately 
and to offer a home visit if problems 
indicate a need. We find, however, that 
the majority of mothers are coping well 
at the time of the initial phone call. 
Mothers are again invited to bring 
their infants to the new infant classes or 
to contact the health unit ifnew 
problems arise. Phone calls generally 
take about ten minutes each. If the 
family has no phone, CH.N.'s decide on 
the basis of risk whether to make a home 
visit or to send a personal note inviting 
the mother to come to the new infant 

3 . New infant classes - When the 
mothers arrive at a new infant class, they 
are greeted by a volunteer who obtains 
records from the clerk, escorts each 
mother to the class and introduces her to 
the others. Frequently mothers have 
been in the hospital at the same time or in 
prenatal classes together and have an 
interest in each other. 

The first ten or 15 minutes of each 
class is devoted to review care of the 
infant and mother in the postpartum 
period. This allows us to discuss the 
materials we would normally present 
during a home visit. Following this, we 
offer a short talk on some aspect of 
preventive health care lasting from ten to 
15 minutes. Topics currently rotated are: 
. baby's nutrition 
. exercises with baby 
. safety through the eyes of a child 
. toys for baby 
. baby's sleep patterns 
Mothers identify with these topics, 
which reflect anticipatory guidance into 
growth and development of the infant, 
and the discussion is usually Ii vely. 
After this discussion, babies are 
weighed and each mother has the 
opportunity to discuss individually any 
concern she may have been hesitant to 
bring before the groupo Some mothers 
return for all five of the discussion 
topics. Others come only once for 
reassurance. New infant classes take 
about one and a half hours of C. H.N . 
time per session. 
Sometimes during discussion of 
topics or individual discussion, the 
C.H.N. will find a mother or infant who 
needs ongoing service: often the mother 
is cognizant of the difficulties but doesn't 
know where or how to obtain help. Other 
mothers, through lack of knowledge of 
growth and development, do not 
perceive potential problems. These 
families are referred to the district 
C.H.N. for further individual follow-up. 

4. Home 
'isits- Home visits are made 
in the traditional manner to high risk 
mothers and those whose telephone 
conversations retl :ct definite problems. 
The difference between the old and new 
system lies in the fact that those needing 
this type of service now receive it 
promptly; the C.HoN. arrives at the 
home more prepared for the specific 
situation, at a time when the mother is 
wanting to learn. Further follow-up may 
be through additional home visits, new 
Infant classes or phone calls. 

The results 
Before we arrived at the fonnat we are 
now using, we conducted an informal 
evaluation of each new infant class 
during the initial shakedown session. We 
also tried to obtain written consumer 
feedback but with poor results; we did 
receive positive feedback verbally and 
the increased utilization of the program 
speaks for itself. 

...,. -.......--...'t.Q.t.I" 

The first formal evaluation of the 
program took place six months after it 
was initiated and input from all nurses 
concerned was obtained. We found that, 
during the first six months, 79 per cent of 
the mothers in the hospital had attended 
postpartum classes, and 31 per cent of 
mothers had attended the new infant 
classes 0 
One of the reasons for not reaching 
our objective of 100 per cent contact with 
mothers in the hospital is that classes are 
held only on Tuesdays and Thursdays 
with the result that some mothers are not 
able to attend. We have not been able to 
arrange optimum spacing as yet, due to 
workloads of hospital and health unit 
staff. The ongoing communication 
between hospital staff and ourselves 
about improving the effectiveness of the 
classes, has promoted an important 
feeling of mutuality in providing care to 
new families. 
Many mothers who wanted to attend 
the new infant classes could not make it 
at the time scheduled so we began to 
have classes on a weekly basis which 
helped overcome this problem. 
Our evaluation indicated the need 
for a system of tabulating telephone calls 
with home visits and a form was 
designed and implemented to meet this 
need. We also recognized the need to 
standardize priorization of high risk 
criteria and have been collecting 
infonnation regarding various systems of 
identifying high risk, but have not yet 
worked through our own 
standardization: each nurse still has to 
use her own judgment. 
The results of our second formal 
evaluation, which took place after the 
program had been in effect for 18 
months, indicated that: 
-the number of mothers attending 
postpartum classes had increased from 
79 to 81 per cent of those eligible. 
-we were able to reach 90 per cent of 
new mothers by telephone. 
-almost one quarter (23 per cent) of 
these mothers were experiencing 
difficulties that warranted a home visit. 
-38 per cent of new mothers attended at 
least one new infant class; the average 
number of classes attended was three. 
-three-quarters of those attending 
classes had concerns which. if they had 
not been dealt with in class. would have 
necessitated a home visit. 
These results have left us feeling 
very positive about our program even 
though we know that we have not yet 
succeeded in reaching all of our goals. 
The steps that we have taken since then 
-to institute monthly meetings between 
maternity nurses andC.H.N.'s 
promoting understanding and continuity 
and resulting, eventually, in improved 
service in both community and hospital. 



Table One 

New infant problems 
observed in classes 

Problem Percent 
Feeding difficulties 26 
Rashes 16 
Inadequate weight gain 10 
Acute illness 10 
Jaundice 7 
Eye discharge 6 
Other 25 

N = 119 

-to request a summer student to update 
and prepare more attractive educational 
materials for both postpartum and new 
infant classes. 
-to continue to work on a priority 
system that will allow better 
identification of risk factorso 
We estimate that impkmentation of 
our new program has saved 
approximately 200 hours of nursing time 
each year that it has been in operation. 
The services we have been able to 
provide under it have bee.1 at least equal 
to, ifnot better than, those that were 
previously available; high risk mothers 
and babies, in particular, have benefited 
from the program. In short, we feel that 
through our postpartum program we 
have found an innovative way of utilizing 
our resources for the benefit of the 
community as a whole. ... 

About the author - Kathleen Nicely 
Freeman, RN, BS, is one of six 
community health nurses working out of 
Quesnel branch office of the Cariboo 
Health Unit in British Columbia. This 
article, "A postpartum program that 
really works", was written with the 
assistance of all of the Quesnel CH N' s 
who participated in the design and 
development of the program. 
Kay is a graduate of St. Anthony's 
School of Nursing and of the University 
of Oregon. She has been involved in 
community health nursing in a mriety of 
positions, including teaching and 
administration in Canada and the US. 





What happens to patients in a long term treatment center 

 I '(
ó {J tr


Barbara Haynes 

The fact that a hospital is an 
institution which serves large 
numbers of people in what is. for the 
most part. an orderly and efficient 
fashion is beneficial to the 
community-at-Iarge. However. when 
people are in hospital for an extended 
period of time. perhaps for the rest of 
their life. the goals of rehabilitation 
and personal independence are often 
hindered by certain ofthe 
institutional aspects of that hospital or 
chronic care facility. 

The sociological definition of an 
institution is 
"an organized system of social 
relationships that embodies certain 
common "allies and procedllres and 
meets certain basic needs of society.' 'I 
When applied to a hospital, one can 
see that the common goals or values of 
the people who work in that institution 
are the cure of Illness and the return of 
patients to a level of functioning at least 
as high as before their admission. To 
meet these goals as efficiently as 
possible, hospitals regulate activities by 
developing specific policies or routines 
for procedures which are applicable to all 

situations occurring within that 
institution. This includes not only 
diagnostic tests but also nursing 
procedures such as dressing changes, 
catheterizations and even bowel 
In other words, the institution 
requires the simplification of actions - 
the organization of human behavior into 
a harmonious pattern. The result is that 
all individuals connected with the 
institution become u
ed or conditioned 
to these patterns or routines. The longer 
the association - in the patient's case, 
his hospital stay - the greater the degree 
of conditioningo 
Why? Part of the reason is that 
patients are not as physicially active as 
they would be normally, nor are they 
required to use their individual 
personalilies and intelligence to make 
decisions and solve problems within the 
highly regulated atmosphere of the 
institutiono !The institution takes over 
many of the individual's former 
Institutionalization then "involves 
the replacement of behavior that is 
spontaneous with behavior that is 
expected. patterned, regular and 
predictable. ".\ 

TO BE.. 


IN 69 


The process of institutionalization 
does serve a function: the "proces
of large numbers of people in an efficient 
fashiono At the same time, it may have a 
detrimental effect. in that it works 
against the long term rehabilitation of 
dependent patients and may even have a 
negative effect on hospital staff. 

The pattern takes shape 
Factors promoting institutionalization 
range from the simple physical realities 
to the more complex issue of human 
behavior. Physical characteristics of a 
hospital ward include uniform decor and 
a generally limited environment. An 
important factor too is the rigid daily 
ward routine of fixed times for meals, 
medications, bathing and bedmaking. 
However, it is agreed that in the 
interest of practicality and patient safety 
many of these physical realities cannot 
be changed, and for the short term 
patient they do not matter that much. In 
a large hospital with a central kitchen for 
instance, meals have to be mass' 
produced for distribution at specific 
times; similarly, it is easier and safer to 
fix times for medications to be given so 
that time is not wasted and medications 
are not forgotten. 
It is the more important factor of 
human interaction that in fact makes the 
process of institutionalization a negative 
one for the long term patient. 

What behavior then, especially on 
the part of nurses, contnbutes 
specifically to the dehumanization of 
patients during institutionalization? At 
least four attitudes have been found to 
have a profound psychological effect on 

where a nurse feels uncomfortable, such 
as when a patient is angry or sad. 
Because she is uncomfortable dealing 
with psychological needs, the nurse 
employs this method unconsciously to 
make ventilation of feelings difficult for 


. labelling. Institutional workers 
often tend to classify or label patients, 
which serves to make the patient less 
than human for both himself and the 
staff; often after a label is applied. a less 
than human response is required for the 
labelled patient. 
. intellectualism. Similar in a way to 
labelling, intellectualism is the focusing 
on a specific problem rather than a 
holistic look at the person with the 
problem. Mr. Jones becomes his 
gallbladder...or hip...or lumbar disc. 
. distancingo Nurses may spend as 
little of their time as possible interacting 
with patients, preferring to give only the 
necessary physical care and no more. 
. humor. While often useful as a 
safety valve for built-up tension, 
humorous remarks made at the expense 
of patients often ensure that staff 
members do not get seriously involved 
with their patients as people. 

It is helpful too to look at the specific 
communication techniques used by 
nurses to examine how dehumanization 
of patients really occurs. 4 
One such style of communication 
can be described as source-oriented. 
People who use this style are generally 
concerned more with themselves than 
with others, and think predominately 
about how they are "coming across". 
This insecurity is manifested in several 
ways: superficial conversation, 
disjointed phrases or non sequiturs, use 
of exaggerated gestures and lack of 
direct eye contact. Source-oriented 
communication is common in situations 

the patient. In a rehabilitation setting this 
is detrimental as unmet emotional needs 
can impede progress. 
Message-oriented communications 
reveal a strong task orientation on the 
part of the staff member;5 she believes 
that the patient's feelings have little 
relevance to the task to be accomplished, 
and shows little interest in how a 
message is received by a patient. This 
situation frequently occurs when nurses 
have a large workload to cope with, or 
when there is not time to handle 

emotional problems effectively Patients 
then see the staff as non-spontaneous, 
mechanical and generally preoccupied 
with the task at hand. 

How the patients feel 
"Without the little things - the smile or 
touch on the arm - the patient feels 
alone and afraid, and really no longer 
human. "R 
In a long term care or rehabilitation 
setting, emotional needs are great; 
patients are often depressed at facing a 
long hospital stay or perhaps a lifetime 
disability. Ignoring these emotional 
needs may result in decreased 
motivation in patients, lessened 
performance and longer hospital stays. 
Basically, the problem is one of loss 
of control. A patient is no longer free to 
choose what to eat or when to eat it (or 
even whether to eat at all), his daily 
schedule is plotted for him, privacy is 
negligible and noise levels 
tension-provoking and distracting. In 
many ways, the person in hospital is 
forced to regress and to relinquish the 
personal independence and control over 
life that he has been handling for years. 
He may exhibit behavior indicative of 
the stress that he is experiencing, for 
example, excessive complaining, 
frequent and unusual demands, and 
refusal to comply with treatment or 
routines. All these are attempts to regain 
control: unfortunately, he risks being 
branded as a 'nuisance' who is 
'uncooperative' . 
In the case of the long term patient, 
the length of his stay within the 
institution usually results in compliance 
- "if you can't beat 'em, join 'em"- 
and there comes a chardcteristic 


dependence, loss of clarity in thinking 
and a decline in physical functioning. 
Changes in routine cause upset and the 
suggestion of discharge may result in 
regression. The patients generally feel 
unable to care for themselves. 7 
The positive aspects ofa strictly 
regulated atmosphere deserve mention: 
it is true that some elderly patients feel 
lost in a strange environment and a daily 
routine serves as a framework to keep 
them in the real world; younger patients 
too who perhaps have less maturity and 
self-discipline benefit from the limits 
imposed by a schedule agreed upon with 
their nurse. 
Obviously, the only way to prevent 
the downgrading of individuals into 
inhuman uniformity is for each nurse to 
develop care plans around the special 
needs of each of her patients, in short, to 
treat them as individuals. 

How to do it? 
To prevent institutionalization, it is 
important basically to recognize the 
effects that certain factors within the 
hospital can have on patients, and to 
remain sensitive to them. Measures that 
promote individuality - dressing a 
patient in his own clothes when possible, 
for example - should be encouraged. 
Anything that helps to create a brighter, 
more stimulating environment will help. 
Control over and responsibility for 
bodily functions such as sleep and 
elimination should be returned to the 
patient, and his participation in 
rehabilitation goal setting should be 
encouraged 0 
Most important though, is the 
nurse's attitude to the patient and the 
realization that her priorities start with 

the patient as an individual, not the 
institution. This basic principle prevents 
the occurrence of source- and 
message-oriented communication and 
encourages instead a type of 
communication which may be called 
receiver-oriented." This style of 
communication recognizes the 
importance of the patient and his 
psycho-emotional needs; he is the 
"receiver" of the messages. The nurse 
who wishes to employ this type of 
communication to her patient's benefit 
must be an active listener; direct eye 
contact, physical proximity and the 
clarification ofthings not fully 
understood are all important. 
Patients in hospital, especially those 
in long term facilities, need to know that 
they are not only caredfor but cared 
about; only then can they return to a high 
level of wellness, both physically and 
mentally. Institutionalization is 
counter-productive, and if the nurse 
wishes truly to perform her role of 
patient advocate - not hospital 
advocate - she must be aware of the 
mechanics of this process. '" 

*Source: Bakal, Donald A. PsycholoRY 
for the Health Sciences: an introductinn. 

I Horton, Paul B. Sociology and the 
health serl'ices. New York, 
ML-Graw-Hill, 1965. p.179. 
2 Taylor, Carol. In horizontal orbit; 
hospitals and the cult of efficiency. 
Toronto. Holt. Rinehart and Winston, 
3 Horton.op.cit. 
4 Veninga, Robert. 
Communications: a patient's eye view. 
Amer.J.Nurso 73:2:321,Febo 19730 
5 Ibid. 

The Canadian Nur.. 

6 Ordeal. Edited by Patricia Chaney. 
Nursing '750 5:6:27-40, Jun. 1975. 
7 Jones, Claudella A. Bums: the 
home stretcho.oRehabilitation, by 
Claudella A. Jones and Irving Feller. 
Nursing '77. 7:12:54-57. Dec, 19770 
8 Veninga. op.cit., p.322. 

1 *Bakal, Donald Ao PsycholoRY for 
the health sciences: an introduction. 
2 Bernard, Jessie. Sociology: nurses 
and their patients in a modern society, 
by Jessie Bernard and Lida F. 
Thompson. St. Louis, Mosby, 1970. 
3 Horton, Paul B. Sociology and the 
health sen'iceso New York, 
McGraw-Hili, 1965. 
4 Jones, Claudella A. Bums: the 
home stretch..,Rehabilitation, by 
Claudella A. Jones and Irving Feller. 
Nursing '777: 12:54-57, Dec. 19770 
5 Lundberg, George A. Socinlogy, 
by George A. Lundberg et al. 4th ed. 
New York, Harper Row, 1968. 
6 Mciver. Vera. Freedom to be: a 
new approach to quality care for the 
aged.Canad.Nurse 74:3:19-26, Mar. 
7 McI vor, Janet. One day the door 
closes. by Janet Mcivor and Lois 
Sorgen. Canad.Nurse 74:3:30-33, Mar. 
8 Ordeal. Edited by Patricia Chaney. 
Nursing '755:6:27-40, Jun. 19750 
9 Taylor, Carol. In horizontal orbit; 
hospitals and the cult of efficiency. 
Toronto, Holt, Rinehart and Winston, 
10 Veninga, Robert. 
Communications: a patient's eye view. 
Amer.J.Nurs. 73:2:320-322, Feb. 1973. 

*Unable to verify in CNA Library 

Barbara Haynes wrote this article while 
enrolled as a student at the Foothills 
Hospital School of NursinR in Calgary. 
Since graduating, she has been working 
at the United Church Hospital in Bella 
Bella. BoC. 




U.r,..h 1 QM .



An Old Enemy with a New Name 

Erna J. Schilder 
Since its first appearance in North American news headlines in 1976, Legionnaire's Disease has been regarded by the 
public as a mysterious and frightening killer. This nurse reviews medical literature to help dispel some of the mystique. 

Three years after the first reported 
outbreak of Legionnaire's Disease. the 
disease is once again in the headlines. In 
August 1976, newspapers excited the 
public with reports of the existence of a 
mysterious and fatal diseaseo The news 
.,tories followed the development of the 
disease after the American Legion 
Convention held in Philadelphia. 
Pennsylvania, July 21st to 24th, 1976. 
Twenty-nine people died, and the 
mysterious pneumonia-like entity was 
named Legionnaire's Disease.' 
Since that time, outbreaks of the 
same disease have been identified in 
other parts of the U.S. and Canada. most 
recently in Toronto. Just last Summer, 
The Globe and Mail reported on August 
7, 1979 that 10 to 12 residents of 
Metropolitan Toronto were believed to 
have contracted Legionnaire's Disease; 
several of these cases were later 
confirmed. 2 
While it is true that not a great deal 
is known about this particular disease 
organism, Legionnaire's Disease is not 
quite as mysterious nor as terrifying as 
the newspapers make out. 

LeRionel/a pfle/lnlophila is the causative 
organism in Legionnaire's Disease: there 
are 4 sero-groups, and the symptoms 
manifested are as with any pneumonia, 
together with G I and CN S symptoms. 
The reservoir for the organism is not 
known; excavation sites are believed to 
be implicated and once, in Bloomington, 
Indiana when 19 people contracted the 
disease, the organism was cultured from 
water in a roof-top air conditioning unit. 
The bacteria is probably air-borne, and 
its incubation period is not known for 
certain but is possibly one to ten days. 

48 Merch 1880 

It was in January 1977 that the 
Center for Disease Control in Atlanta 
Georgia announced it had discovered the 
organism." Problems encountered in 
identifying the disease were due to the 
huge number of studies that had had to 
be done to rule out all other possibilities, 
before focusing on the search for a new 
causative organism. 
Studies have found that legionella 
pneumophila grows slowly, in five to 10 
days, when incubated at 35 0 C on 
chocolate agar plates, after being 
obtained from pleural fluid or lung 
tissueo I A more expedient means of 
establishing the diagnosis has since been 
developed: serum of an affected patient 
can now be tested for antibodies, and a 
definite diagnosis can be made if there is 
a rise in titre. 

Clinical manifestations 
Two to 10 days after exposure to the 
organism, a patient may exhibit 
symptoms of malaise, myalgia and slight 
headache. Within 24 hours a high fever 
of 39 0 C to 41 oC may develop associated 
with chills. dyspnea. and a 
non-productive cougho Other symptoms 
of chest pain, abdominal pain andGI 
disturbances may also be present. Many 
patients have rales on auscultation 
without other evidence of consolidation. 
Laboratory findings include 
leukocytosis, proteinuria, an elevated 
ESR - greater than 80 mm/hr in most. 
In some patients there may also be 
hyponatremia, mild azotemia and 
elevated SGOT and alkaline phosphatase 

Th. CanadIan Nur.. 

Chest x-rays commonly 
demonstrate unilateral involvement and 
pleural effusion; the one-sided lung 
consolidation rapidly expands into lobar 
involvement..; The disease usually 
worsens over the first two to three days; 
the cough becomes productive at this 
time, but the sputum is rarely purulent. 
Although both sexes are 
susceptible, mortality due to 
Legionnaire's Disease is higher in male 
patients.';Gastrointestinal bleeding is 
frequently present. and the patient 
eventually succumbs to either shock, 
respiratory failure, or both. Renal failure 
has been reported in several patients and 
is probably secondary to the respiratory 
involvemenl. In patients who recover, 
improvement generally lags several days 
behind the evidence in x-rays. 
The description of this disease might 
give one the impression that there is little 
difference between Legionnaire's 
Disease and the usual bacterial 
pneumonia. The distinguishing features 
of this disease, however, are high fever, 
non-productive cough, no 
micro-organisms cultured or seen in 
smears from sputum, leukocytosis, 
evidence of consolidation in chest 
x-rays. and - significantly - there is no 
response to the usual anti-microbial 
treatment for pneumonia. 
Since the mortality rate currently 
rests at 15 percent. a firm diagnosis at an 
early stage of the disease is of crucial 
importance in implementing appropriate 

Medical treatment of Legionnaire's 
Disease is aimed at the relief of 
presenting symptoms and the prevention 
of complications. 

\ ... \.. 

- , 
" )' 
, - 
 - .. 


After several studies. researchers 
have concluded that erythromycin is the 
antibiotic that is cunently most effective 
in treatment of this disease. Patients who 
do not respond well to erythromycin 
alone should receive a combination of 
erythromycin and rifampin. 
Of particular importance in therapy 
is the maintenance of metabolic and fluid 
requirements to support the restorative 
processes in the acutely ill febrile 
patient. Respiratory care must be aimed 
at maintenance of adequate oxygenation. 
good tracheal-bronchial hygiene, and 
support of the dyspneic patient. 
Nursing care ofthe patient with 
Legionnaire's Disease has two distinct 
goals: first is the promotion and 
maintenance of a comfortable and safe 
(i.e. hygienic) environment. Isolation is 
not necessary in the care of these 
patients, but steps must be taken to 
avoid secondary infection. 
Second, observation of the patient is 
crucially important for the nurse. The 
patient must be observed for any change 
- marked restlessness associated with 
severe dyspnea and a respiratory rate of 
more than 40 per minute are signs that 
the partial oxygen tension (PO
) has 
fallen below 60 mm Hg in arterial blood. 
This must be prevented as respiratory 
failure and shock are the final outcome. 
Vital signs too should be closely 
monitored as they are indications of 
impairment of physiological function: 
intake and output measurements. 
evaluation of cough. noting the presence 
of pain, and monitoring laboratory 
findings are other important nursing 

Finding out 
Contrary to the impression created by 
the press. Legionnaire's Disease is an 
old disease with a smart new name. It 
was simply one more unidentified killer, 
until 29 people died from it at once in 
1976; it is thought that Legionella 
pneumophila affects an estimated 25.000 
people a year in the U. S., 2500 in 
Canada, but most of the patients' 
diagnoses are only suspected, not 
confirmed. ' 
Information about the disease is 
now available and it behooves the 
nursing profession to learn more about 
this old enemy. ... 

I *New Yor/.. Times Index, 1977. 
2 *Glohe and Mail. Toronto, Aug. 
7th and 8th, 1979. 
3 *New Yor/.. Times Index, 1977. 
4 *Centerfor Disease Control. 
Legionnaire's di.fease: preliminary 
report on its diagnosis, etiology, 
pathology and therapy. Atlanta, Ga.. 
U.S. Oept. of Health, Education and 
Welfare. Public Health Service, Center 
for Disease Control. 1977. 
5 *Dietnch, P.A. The chest 
radiograph in legionnaire's disease, by 
P.A. Dietrich et al. Radiolog\' 
127:3:577-582, Jun. 1978. 
(, *Waters, J .R. Leginnnaire's 
disease. Winnipeg, Grand Rounds 
Health Sciences Centre, Oct. 1977. 
7 Fraser. D. W. Antibiotic treatment 
of guinea-pigs infected with agent of 
Legionnaire's disease. by D. W. Fraser et 
al.Lancet. 1:8057:175-178,Jan. 1978. 

The Canacllen Nur.. 



I l 






8 *Glohe and Mail, Toronto, Aug. 
8th, 1979. 

1 Fraser, D.W. Antibiotic treatment 
of guinea-pigs infected with agent of 
Legionnaire's disease, by D.W. Fraser et 
al. Lancet 1 :8057: 175-178, Jan. 28, 1978. 
2 *Globe and Mail, Toronto, Aug. 
7th and 8th, 1979. 
3 *Morbidity and mortality. Wee/..ly 
Report. Aug.l\. 1978. 
4 *NewYor"Timeslndex 
5 *Center for Disease Control. 
Legionnaire's disease: preliminary 
report on its diagnosis, etiology, 
pat/lOlo!?y and therapy. Atlanta, Ga., 
U.S. Dept. of Health, Education and 
Welfare. Public Health Service, Center 
for Disease Control. 1977. 
6 .Waters, J oR. Legionnaire's 
disease. Winnipeg. Grand Rounds 
Health Sciences Centre, Oct. 1977. 

*Unable to verify in CNA Library 

ErnaJosefine Schilder,RN, BN, MA, is 
currentlv an assistant profe.Hor at the 
Uni\'ersity of Manitoba School of 
Nursing. She has a varied clinical 
experience, hm'ing wor/..ed in hospitals 
in Germany, Holland and England, and 
since in Canada has been im'oh'ed in 
stajJnursing, nursin!? administration and 
teaching in Manitoba. 

Merch 18110 47 

Fundamentals of Nursing 
Concepts and Procedures 
Burbara KOller. R N 
Glenora Erb R N 
Presents concepts and skill ac1 Jally 
used In CXJmrTllJnlty health as well as 
hospital nurSing Comprehensive and 
complete coverage of tOpiCS makes 
the text Ideal for study or review and 
this handsome. gold-stamped 
vrlume will be a Icr'lng Invc;tmentln 
, Jur nursing career 
3'104-4 $265ú 
Psychiatric NursIng 
Holly S Wilson. R I Ph D 
! oral R Knelsl R I\' M 
Wntten from a perspe,
tlve of 
humanism and 
ymbol - Interac 
. Jnlsm thiS text IS speCifically de- 
signed ta enhance holistic nursing 
philosophies while prOViding a 
thorough presentation of the cf")ntent 
and concepts f")f psychlatnc nun;lng 
Attracltve gold-stamped volume will 
become an enduring port of your 
reference library 
b34f'-X jL 

Obstetric Nursing 
SallyB OIds.RI',.M 
Marcia London. R NBC' , M 
Patncla Ladewig. r. ., M C' . , 
Sharon V Davidson M Ed 
A comprehensive exp- 'Ion of the 
theory and pracltce r )bstetnc 
nurSing With emphas.. )n the 
blolNjIC'al needs of the ""hole 
patler" and her fan oily ,..I, useful 
well-III trated referenre for 
prac Ing nurse
 )r f" dent 
2718-0 $27 ! 
The Nursing Process:A 
Humanistic Approach 
Elaine l Lamonlc.) I, t, -. 
A humanistic apprCXJ,-h, d M ]ned t(' 
Increase the nurses empathy With 
 tlVlty for ;lIents and C -'- 
omprehenslve <- :Nerage 
of tOpiCS makes thiS text a va1uable 
reterenee tCXJI 
41:<13-"< :;1575 

Nursing the Critically III Adult 
t ar 'Y H
,lIoway r' \.1 
Wntten b Jle r e 
Helpful In reviewing proolen related 
to patient s ng :;are needS 
- ontalnlng po ent outcome cntena 
to help you evalu'1te the '1uallty of 

JUr ,::ore Test<Yj pragmatIC and 
practical I 
,,':;>48 () """ 7') 
Communicable Disease 
Manual for Primary Health 
Care Professionals 

I If '1PH 
r ,J1 PH 

p. N'-jes "'are In"'...." ,a" () tc 
1nr"'ng - ,an
,lng and 
JI ,tr,-lIlrl,nfec" 
nmonlY seen In a pnmary -'are 
setting . "lulck referene 9 for nurs 
health E and publ health 
392-7 ,..17 

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Please find a cheque enclosed 
If payment" en<. i lIPl-rngthandhlY) w I be pa'rJ 

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/' the following htles. 
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Computers in the 
Practice of Medicine 
Part I: Introduction 
Part II: Issues in Medical 

H "mini< >lV,-, 
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,,1IS un'':1ue sou":;ebüv. nt, 
I os' mputer ha''jW'"1re ')r,j 
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[he Sl j volume Intnduces It1P 
relevanT S Ir le\ ' ping and 
plpf1lent : In 
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vementteyt IN 
health ")re p'')fes'lonal' 
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Being a nurse and an officer in the Canadian Forces offers 
many advantages. If you're a Canadian citizen and a graduate 
nurse (female or male) of a school of nursing accredited by 
a provincial nursing association and a registered member of a 
provincial nurses' association with two year's experience 
why not combine two careers in one? 
For more details, contact your nearest Canadian Forces 
Recruiting Centre in the Yellow Pages under "Recruiting" 
or return the coupon. 


I Director of Recruiting and Selection I 
I National Defence Headquarters I 
I Ottawa, Ontario, KiA OK2 I 
I I 
I Name I 
I I 
I Address I 
I City Prov Postal Code I 
I I 
I Telephone Number I 
CN-1-RO I 

The Cenadlen Nur.. 

M.rch 19110 49 




By Margo McCaffery, RoN., MoS. 
Since more information was available but pub- 
lishing space was limited, it was decided that 
the greatest contribution to nursing practice 
could be made by restricting the focus of this 
edition to nursing ..ctivities for pain relief and 
covering this content in more deptho The 
first edition encompassed all phases of the 
nursing process, from assessment and diagnosis 
through intervention to evaluation. This edi- 
tion focuses primarily on nursing intervention, 
elaborating on most of the intervention me- 
thods included in the first editiono Lippincott. 
338 Pages. Illustrated. 1979. $19.000 


Edited by Doris L. Carnevali, R.N., MoNo; and 
Maxine Patrick, RoN., Dr.PoH. 
This book is written for practicing registered 
nurses and students who care for older people 
as part or all of their case load. We expect our 
readers to have a variety of educational and 
experiential backgrounds. To this end the areas 
are presented with sufficient depth to encour- 
age more than a superficial approach to nursing 
Lippincott. 569 Pageso 
Illustrated. 1979. $22050. 

A Self-Assessment Manual 
By Marilyn Frank-Strom borg, RoNo, Ed. D., NP; 
and Paul Strom borg, MoD. 
This workbook/text is designed to provide a 
self-assessment of skills in physical assessment, 
medical management of diseases, health coun- 
seling and coordination of community resour- 
ces for health promotion. The material is 
oriented to the nurse involved in primary health 
care in an adult and adolescent ambulatory care 
setting. It may be used to supplement class- 
room studies in a nurse practitioner proF;ram, as 
a continuing education device for the graduate 
nurse practitioner, or as a senior level manual 
for baccalaureate programs involved in the pre- 
paration of nurses for the primary care setting. 
Lippincott. 329 Pageso 
lIIustratedo 1979. $16050. 



. .! nI 
I I , . . , .. t 
skiUs r - .NIIna: 
A Scf "r 1Tr'l1r''I" ...... 




r-;VRSU\G: Process and 
Product, 2nd Edition 
By the Nursing Development 
Conference Groupo Edited by 
Dorothea Eo Orem, RoN., M.S.N.Ed. 
This volume refines previous conclu- 
sions and moves on to descriptions of 
the individual or group dynamics asso- 
ciated with fonnulation, expression, 
and acceptance of nursing's conceptual 
It will serve as an important reference 
for teachers and students of nursing, 
nurse practitioners, nursing adminis- 
trators, and all who have an interest in 
nursing as a unique discipline. 
Little, Brown. 313 Pageso 
Illustrated. 1979. 515.50. 

CARE, 2nd Edition 
By Catherine DeAngelis, M.Do, RoN., 
MoP.H_, F.A.A.P. 
Written to impart to members of the 
pediatric primary health care team 
specific, pertinent knowledge that has 
been carefully selected from the broad 
field of pediatrics. 
Little, Brown. 676 Pageso Illustrated. 
1979. Paper, 515.00. Cloth. 521.00. 


By Susan Fickertt Wilson, M.No 
For nurses in neurological and neuro- 
surgical acute-care settings, medical- 
surgical and pediatric wards, and 
rehabilitation units. A useful text for 
nursing education and clinical practice. 
Springer. 272 Pages. 
Illustrated. 1979. $21.00. 

Comprehensive Nursing 
By Patricia McCall Comoss, R.No, 
CCRN.; et. alo 
One of the most exciting features of 
the rehabilitative approach to the 
patient with symptomatic coronary 
disease has been its progressive incor- 
poration into the mainstream of 
traditional medical care. 
Lippincott 0 334 Pages. 
Illustrated. 1979. 520.25. 

PRACTICE, 2nd Edition 
By Lillian Sholtis Brunner, R.N., B.So, 
M.SoN.; and Doris Smith Suddarth, 
R.N., BoSooVoE., M.S.N. 
With 9 Contributors. 
The most comprehensive single-volume 
reference on nursing practice ever 
published. Hundreds of illustrations 
depict the highlights of treatment and 
nursing management (over 100 illus- 
trations are new!). 
Lippincott. 1,868 Pages. 
Illustrated. 19780 $32.25. 


By Harriet Lucille Schneider, R.N., 
B.SoN.Eo, MoA., M.Ed., EdoD. 
This intriguing text explores all facets 
of an old and perplexing problem-the 
evaluation of clinical nursing compe- 
tence. Specific fonns, checklists, and 
sets of questions are provided for 
evaluative purposes. 
Little, Brown. 175 Pages. 
Illustrated. 1979. S8.50. 

 B. LiPP ::: :::-Y of cana
 o , 75 HO=o, Toronto, ont
I 0 Payment enclosed (postage and handling paid) 
o Bill me (plus postage and handling) I 
Please send me the following 'on approval': 
I 0 Nursing Management of the Patient With Pain, 2nd Edition: $19.00. I 
o !\ursing Management for the Elderly: $22.500 
;ry ca;

ssess:ent a;d M
agem:nt Sk
IS forgNurse;: U6;

 10-CI I 
I Address I 
City Provo Postal Code 
I Prices subject to change without notice. J 


Edited by Stewart M. Brooks, MoS. 
A comprehensive reference on all 
drugs commonly encountered in nurs- 
ing practice. More than 500 mono- 
graphs covering all drugs which the 
nurse will encounter in nonnal prac- 
Little, Brown. 500 Pages. 1978. 


By Charlotte Kopelke Eliopoulos, 
Gerontological Nursing gives compre- 
hensive treatment of the subject with 
a balanced coverage of psychosocial 
factors, pathophysiology and nursing 

Harper & Row. 384 Pages. 
Illustrated. 1979. 515.00. 

9 CO

By Voncile M. Smith, Ph.D.; and 
Thelma A. Bass, M.Ao 
This timely book identifies and des- 
cribes problem situations stemming 
from communication breakdowns that 
commonly affect health care person- 
Lippincott. 236 Pages. 1979. $7.50. 


By Robert Kolodny, M.D.; et. at. 
This comprehensive work on human 
sexuality provides the nurse with a 
knowledge of human sexuality that 
will enable her to care for her patient 
in the emotional and social, as well as 
the physical realmso 
Little, Brown. 431 Pageso Illustratedo 
1979. Paper, $15.000 Cloth, $21.00. 

You and the law (continued from page 16) 
contraceptive reasons on a mentally 
retarded persono He further concluded 
that in the absence of clear and 
unequivocal statutory authority, except 
for clinically therapeutic reasons 
(preservation of life, safeguarding of 
endangered health) neither parents nor 
those standing in loco parentis can give 
consent to such surgery on behalf of 
minors or retarded adults who 
themselves are unable to give informed 
In the words of His Lordship: 
"The Eves of this world, regardless of 
how retarded, are, nevertheless, per.wns 

with rights which the Courts must 
presen'e and protect. One of these rights 
is the inviolability of their persons from 
involuntary trespass 0.. While the 
preservation of this right might well, and 
even predictably, result in no little 
inconvenience and expense, and indeed, 
even hardship to others, the Court must, 
regardless of its own natural sympathy 
to those others, ensure that the law have 
the care of those who are not able to care 
for themselves, and ensure the 
pre sen'ation of the highe r right... 
...Thefundamental issue here is not 
Eve, per seo Rather it is whether, under 


.-.-. . 


'lust as I thought.. ." 

It's more than good-tasting, it's good medicine. 
Antibacterial, antifungal.lozenges 
''(f fJlí!!f/!A!!!
'!!!!l!!lif!.! D 

52 Merch 1980 

The C.nadlen Nur.. 

the law as it now stands, the state, 
through the instrumentality of the 
Courts, or otherwise, orthefamily, be its 
members parents, or in the case of the 
elderly, children, have the right to take 
upon themselves the subjective 
prerogative of altering irreversably by 
medico-surgical procedures the lives of 
others who may, for whatever reason, be 
incapable of making that decision for 
themselves, in a manner which will 
deprive them of any of their faculties as 
human beings, other thanfor the 
preservation and protection of health , or 
the preservation and protection of 
quality oflifeo The law, as I see it, does 
not permit this to be done. "II ... 

I In the Matter of "Eve", a mentally 
incompetent person, in the Supreme 
Court (Family Division) of Prince 
Edward Island, June 14, 1979 published 
in the Report of the Ontario 
Intenninisterial Committee on Medical 
Consent, (Part one) Gilbert Sharpe, 
Chainnan, September 1979, p.39. In ReE 
(1979) 10R.F.L. (2d) 317. 
2 SkJar, C. Teenagers, Birth Control 
and The Nurse. CanadoNurse 
74:10:14-16, Nov. 1978. 
3 SkJar, C. Legal Consent and the 
Nurse.CanadoNurse 74:3:34-37, Mar. 
4 For more specific detail see SkJar, 
C. Minors in the Health Care Systemo 
Canad.Nurse 74:8:18-20, Sept. 19780 
5 (1949) 2 D. L.R. 442. 
6 In the Matterof"El'e". p.321. 
7 Id p.324. 
8 (1979) 7C.C.L.T. 241 (Quebec 
9 ReD(aMinorJ,[1976]IAllE.R. 

"Eve". p.328. 
Id p.329. 

"You and the law" is a regular coillmn that 
appears each month in The Canadian Nurse 
and L'infirmière canadienne. Author Corinne 
L. Sklar is a recent gradllare of the University 
of Toronto Faculty of Law. Priorto entering 
law school, she obtained her BScN and M S 
degrees in nursing from the University of 
Toronto and University of Michigan. 

- -- 



Introducing the 1980 


As an essential part of the health care team, more is 
demanded of today s nurse. .. so you demand more of your 
text. Updated, revised and expanded-the new Second 
physiologic Approach keeps pace with the needs of 
today's nurse. .. to supply nurses with the knowledge and 
confidence to undertake ever-increasing responsibilities. 
Just a sample of the updated and expanded chapters: A 
rigorously revised and expanded section on Shock in- 
cludes such topics as hemodynamic monitoring II central 
venous pressure II peripheral and central arterial moni- 
toring II the use of the Swan-Ganz catheter II the intra- 
aortic balloon lJump II external counter-pulsation device 
II and hyperbaric therapy, The unit on a Holistic Approach 
to Illness, including responses to stress-producing 
factors, discusses such topics as Benson's relaxation 
response II transcendental meditation II hypnosis II auto- 
genic training II biofeedback II and yoga. While all material 
has been thoroughly revised, particular aitention has 
been given to rewriting, updating and expanding the 
cancer, immunology. renal and liver, and male repro- 
ductive system sections. 
Completely new material: Entirely new units on psycho- 
social and physical assessrænt, emergency nursing, and 
dependency on alcohol and other substances are in- 
cluded. In addition, the opening chapters emphasize the 
importance of nursing as an art and a process. Plus many 
new illustrations provide a balance with the textual 
material... and an Instructor's Manual has been prepared 
to accompany this text. 
Concise, yet comprehensive: MEDICAL-SURGICAL 
NURSING can be used in conjunction with or inde- 
pendently from Sorensen & luckmann's BASIC 
NURSING. Content has been carefully divided between 
the two texts, reducing unnecessary repetition... and 
therefore eliminating wasted reader time and baokspace 
-crucial factors in a dynamic profession with a rapidly 
expanding knowledge base. Plus important matenal on 
fluid-electrolyte acid-base, pain, physical assessment 
and emergency life support bridge bath books. ., the 
fundamentals in BASIC NURSING and the more ad- 
vanced principles in MEDICAL-SURGICAL NURSING. 

Luckmann & Sorensen 

a psychophysiologic approach 
New 2nd Edition 

By Joan luckmann, RN, BS, MA. Formerly, I nstructor of 
Nursing, University of Washington, Highline College, 
Seattle, Oakland City College, and Providence Hospital 
College of Nursing, Oakland, CA; and Karen Creason 
Sorensen, RN, BS, MN, Formerly, lecturer in Nursing, 
University of Washington; Formerly, Instructor of Nursing, 
Highline College; Formerly, Nurse Clinical Specialist, 
University Hospital and F:lland Sanatorium, Seattle, WA. 

. About $40.80. 
. March 1980 
. 2276 pp. 
. Illustrated 
. Order #5806-7 

I 1 



Send on no-risk 3O-dayapproval: I 
I Luckmann & Sorensen I 
I 0 check enclosed- SlIunder.; peys postllge I 
Please Pro nt 
L. CN 3/80 ... 

The soft touch 
for tender tissues. 

Book Corner 

Publications recently received in the 
Canadian Nurses Association Library are 
available on loan to CNA members, schools 
of nursing and other institutions. 
Requests for loans, maximum 3 at a time, 
should be made on a slandard interlibrary loan 
fon1'l or on institutional letterhead if the 
institution has no library. 
If you wish to purchase a book, please contact 
your local bookstore or the publisher. 

Occupational alcoholism and drug abuse; 
employerresponsibility, by Mary S. 
Lamontagne. n.p., 1979. Iv. (various pagings) 

Child Care 
Maternity and child care services: 
relationship to parentI infant and parentI 
child relationship; a clinical study. A report to 
World Health Organization, by Colleen M. 
Stainton.Geneva World Health Organization, 
1979. 55p. 

Community Health Services 
Community health - today and tomorrow by 
the National League for Nursing. New York, 
cl979. BOp. (NLN Pub. no. 52-1768) 

A practical education program for the diabetic 
client within the rehabilitation setting, by 
Nancy Dyer and Pat Homeyer. New York, 
American Foundation forthe Blind, 1979. 

Dictionaries, Medical 
English-French dictionary of medical and 
paramedical sciences by WilliamJ. 
Gladstone. St. Hyacinthe, Edisem, 1978. 

... 4 c::--. 
.. 100 e" A' 
1f'W CKS* 
.. ano , &:- 
íX' ... 
Pre-Moistened Pads æ.'J 
c '. 
For hemorrhoids, feminine ..."""".' 
hygiene, piles and personal wait''- 
itching problems. tl,:jJiÍ" 
CII/i., ....lti.'. .sl,;."., , 
-RegIstered trademark of Parke, Davis & cornpan ( 
Parke DaVIS & Company Ltd 0 regIstered use 

Education, Nursing 
Instruments for use in nursing education 
research by Mary Jane Ward and Mark E. 
Felter. Boulder, Colo., Western Interstate 
Commission for Higher Education. 1979. 

An atlas of diagnostic and therapeutic 
procedures for emergency personnel by 
James H. Cosgriff. Toronto, Lippincott, 
Health care of women by Leonide L. Martin. 
Toronto, Lippincott, cl978. 391p. 

History of Nursing 
Nursing: a world view, by HudaAbu-Saad. 
Toronto, Mosby, 1979. 227p. 

Leadership, Nursing 
Nursing management and leadership in aclion 
by Laura Mae Douglass and Em Olivia Bevis. 
3rd ed . Toronto, Mosby, 1979. 289p. 

Relieve postpartum and postsurgical 
itching and burning with Tucks. 

Nurse- Patient Relations 
Dying in an institution; nurse/patient 
perspectives, by Mary Reardon Castles and 
Ruth Beckmann Murray. New York, 
Appleton.(:entury.(:rofls, cl979. 356p. 

Spiritual care: the nurse's role, by Sharon 
Fish and Judith Allen Shelly. Downers Grove, 
11I.,lnterVarsity Press. cl978. 178p. 


· e · risal1 
cuts the cost of decubitus care 

by controlling 
infection fast 
Debrisan sucks bacteria and tox- 
ins out of decubitus ulcers. The 
ulcer is quickly cleansed, healthy 
granulation appears, and healing 
can begin. 
.. These (wet, exudative ulcers) 
averaged two days to clear the 
superficial infection and five days 
from the onset of therapy to ap- 
pearance of good granulation 
tissue in the ulcer base." 1 



Day 0 Infected, heavily Dey 2 Exudete diminished. Day 14 Clear, healthy 
exudating decubitus ulcer on Erythema and edema granulation base; grafted 
left hip. reduced. successfully. 

"'... "'. 



by relieving 
pain and 
ooour fast 

, ...1. 

Day 0 Infected exudating Day 4 Clear, healthy 
decubitus ulcer on knee. granulation base. 

Day 14 Ulcer healing after 
Debrisen discontinued. 

.. All patients in whom rest pain was 
present at the start of treatment 
noticed almost immediate relief of 
the rest pain when Debrisan was 
applied to the wound."2 
II Debrisan was commenced and the 
following day, the smell had disap- 

Day 0 Undermined sacral Day 7 Surgically debrided Day 28 Appearence on 
decubitus ulcer infected with before Debrisan therapy and healing. 
Pseudomonas and E.coli. after 7 days, infection 

by saving valuable nursing time 
Only one Debrisan change a day. 
is needed. Debrisan therapy can " 
be stopped as soon as all signs of 
infection have gone and the ulcer 
is clean and granulated. 
II Debrisan appears to be, in my 
opinion, just what we as nurses 
are seeklng."4 


.,._, If exucllltlon I. vøy heeV)'. 

After removing crust or 
necrotic tissue, pour a thick 
(4 mm) leyer of Debrlsan on 
the ulcer. 

Cover with a dressing. 

When the beads are 
saturated (12 to 24 hours 
later) rinse and wipe them 
away. Apply a fresh layer of 

Debrisan e cleans 
decubitus ulcers fast. 

.. Phannacia (Canada) Ltd. 
\I Dorval, Québec 

1. Um L T, Mlchudll M, Bergen JJ, Angiology 29:9, Sept 1978 
2. Bewlclc M, Ancle..on A, Clln Trlel. J 15:4, 1978 
3. Soul J, Brit J Clln Prect, 32:8, June 1978 
4. DiUeeclo S RN, Decubltu. Cere A New Approech: 
A Nuralng Re.ponslblllty, on file et Phllrmecle (Ceneclll) Ltd. 

Reg. T.M. 

Decubitus Ulcers 
An audio-visual 
presentation available 
on loan, free of charge 

This presentation describes treat- 
ment and dressing techniques for both 
simple cutaneous and deep decubitus 
ulcers, using BenOxyl 20% (benzoyl 
peroxide) Lotion. 
The taped narrative, by W.E. Pace, 
M.D., M.Sc., F.RoC.Po(C) and Heather 
Hanson, R.No, runs for approximately 
30 minutes and is supported by a series 
of before-and-after illustrative colour 
To complement the slide-tape pre- 
sentation a folder illustrating the dress- 
ing techniques is available in quantity. 
For any of the above material, 
including a complete script, please 
write to: 
Scientific Services Dept. 
Stiefel Laboratories 
(Canada) Ltd. 
6635 Henri-Bourassa Blvd. W. 
Montreal, Quebec H4R tEt. 




Antiflatulent Simethicone 

OVOL is indicated to relieve bloating, 
flatulence and other symptoms 
caused by gas retention Including 
aerophagia and infant colic. 
None reported. 
Protect OVOl DROPS from freezing. 
None reported. 
Simethicone 80 mg 
Simethicone 40 mg 
Adults: One chewable tablet between 
meals as required. 
Simethicone (in a peppermint 
flavoured base) 40 mg/ml 
Infants: One-quarter to one-half ml as 
required. May be added to formula or 
given directly from dropper. 

Y Montreal Canada 

Nursing Care 
Nursing assessment and health promotion 
through the life span, by Ruth Beckmann 
Murray and Judith Proctor Zentner. 2d ed. 
Englewood Cliffs, N .J., Prentice-Hall, c 1979. 

The cesarean birth experience: a practical, 
comprehensive, and reassuring guide for 
parents and professionals, by Bonnie 
Donavan. Boston, Beacon, cl977. 24Op. 
OccupatlonaJ Health Nursing 
Report on the feasibility of establishing a 
post-registration designation or certification 
program for occupational health nurses in 
Ontario by Ontario Occupational Health 
Nurses Associationo Mississauga, Ont., 1979. 

Ovol Drops 
infant colic. 





Care of the high risk neonate by Marshall H. 
Klaus and Avroy A. Fanaroff. Toronto, 
Saunders, 1979,437p. 
Child health maintenance; concepts in 
family-centered care by Peggy L. Chinn. 2d. 
ed. Toronto, Mosby, 1979. 934p. 
A healthy child, a sure future by the World 
Health Organization. Geneva, 1979. 
Pharmacology and drug therapy in nursing by 
Morton J. Rodman and Dorothy W. Smith. 2d 
ed. Toronto, Lippincott, cl979. 1085p. 
Single- Parent FamiI) 
One in ten; the single parent in Canada, by 
Benjamin Schlesinger. Toronto, University of 
Toronto, 1979. 15Op.... 






Ovol Drops contain simethicone, 
an effective, gentle antiflatulent 
that goes to work fast to relieve 
the pain, bloating and discomfort 
of infant colic. Gentle pepper- 
mint flavoured Ovol Drops. 
So mother and baby can get 
a little rest. 

Oval DilP3 


fs . actmg 

I :::Ianl 
Shhh. Ovol Drops. Also available on tablet Conn [or adults 


A@'Goo F 

 \ -

&. As:s 

!, ld!e

Industrial Psychologists - Management Consultants 


This newly-created Edmonton position offers the opportunity to contribute to the development of a well recognized 
nursing management system. Our client, an innovative SOG-bed active treatment and teaching hospital, offers a wide 
range of patient care services. The individual appointed to this senior position will plan, organize, direct and evaluate the 
nursing care throughout the hospital. 
Competitive candidates will have proven nursing management experience, strong leadership and interpersonal skills, 
and good communication abilities. Required is a Bachelor's degree in Nursing; preferred is a Master's degree with 
experience at Director or Associate Director levels, 
Rewards include an excellent salary and benefits package, a challenging and stimulating work environment with a 
professionally accomplished nursing team. 
To inquire in strict confidence, contact Larry Pelensky in our Edmonton office by writing or Collect phone with an outline 
of your education and accomplishments. 

11207 - 103 Avenue, Edmonton, Alberta, T5K 2V9. 


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TO.. ,. 

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These children speak an international 
language of love. With one smile, they remind me 
why I b




: place. " 









Pnor Dow 
(519) 376-6809 
Assoc. . Ltd. 
J61 10th S..W 

f' -i 

Owen Sound. 
Ontario N4K3R4 

, ... 



The Arabian Peninsula. comparable to mO!,t Canadian talking to other Canadian 
Different. Demanding. And facilities. And. when my shift nurses about it. And some day 
most decidedly gratifying. was over, I went home to an I'm going back there." 
"When I first went to SaudI attractive, free, air-conditioned Dorothy Redden's reactions 
A abla I expected to always a p artment. The travel benefits 
r . are typicaL And Whittaker, 
be giving. I never expected to were tops too. And my salary a leader in international health 
get so much In return From and Y ear-end bonus were g reat. 
. . care, IS now offering contracts 
grateful parents. Smiling All in all, the experience was in either Saudi Arabia or Ahu 
h Id A d 0 e nnlent invaluable. Which is wh y I'm 
c i ren. nag v r Dhabi. If you're a Canadian 
that respects everything that we trained RN with 2-3 years 
Americans can do to help_ Dedicated postgraduate experience, c
The hospital itself was really us today on our Toll Free Ime. 
to a world of health 
UY hittakelt 

Whittaker International Services Company 
A Subsidiary of Whittaker Corporation 
An Equal Opportunity Employer M/F 



Registered Nursrs reqUIred for a 
60-bed acute care 
hospital in Edmonton. Alberta. Positions available in 
most clinical areas. Candidates must be eligible for 
registration in Alberta. Current salary rates under 
review. Apply to: Personnel Department. Edmonton 
General Hospital. III I I Jasper Avenue. Edmonton. 
Alberta n... OL4 

Regletered Nunes required for full time work on 
Medicine and Pediatrics as well as Surgery and 
Maternity. To work rotating shifts. Positions.availa- 
ble immediately. Apply to: Director of Nursing. St. 
Joseph's General Hospital, P.O. Box 490. Veg- 
reville. Alberta TOB 4LO. Phone: 1-403-632-2811. 

British Columbia 

Asøoclate Director of Nursing required for a 142 
acute. 7
 Extended Care bed Fraser Valley Hospital. 
Excellent career opportunity for a qualified. innova- 
tive individual involving responsibility for a broad 
area of nursing service. Principle role will be patient 
care co-ordination (Clinical). Administrative experi- 
ence and B.S.N. preferred. Apply in writing to: 
Director of Nursing, Matsqui-Sumas-Abbotsford 
General Hospital. 2179 McCallum Road. Ab- 
botsford. British Columbia V2S 3PI. Phone: 8

Staff Nunes required for the following areas: 
Psychiatry. Extended Care and Medical. Eligibility 
for Registration in B.C required. Formal training 
and/or experience preferred. Apply in writing to: 
Director of Nursing, Matsqui-Sumas-Abbotsford 
General Hospital. 2179 McCallum Road. Ab- 
botsford. British Columbia V2S 3PI. Phone: 8

Experienced General Out} Graduate Nurses required 
for small hospital located N .E. Vancouver Island. 
\faternitv experience preferred. Personnel policies 
according to RNABC contract Residence accom- 
modation available $30 monthly. Apply in writing to: 
Director of Nursing. St. George's Hospital. Box 223, 
Alert Bay. British Columbia. YON IAO. 

The "boom" of our nonhern city continues! We still 
require beginning or experienced practitioners for our 
nursing departments. If experienced. we will give 
you opportunity to try some of your ideas. If 
beginning. we will give you Opponunity to expand 
your skills and knowledge. Contact: Mrs. A. 
Henriksen. Nursing Director. Dawson Creek and 
District Hospital. 11100 13th Street. Dawson Creek. 
British Columbia VIG 3W8. 

Operating Room Head Nunr-Must be RNABC 
registered. Must have experience in all O.R. 
procedures. Salary: according to the RNABC 
Agreement. Please apply in writing to: Mrs. A. 
Houghton. Director of Nursing. Fort St. John 
General Hospital. 9636-l00th Avenue. Fon St. 
John. British Columbia VIJ lY3. 

GeDerai Duty Nunes-Must be registered with 
RNABC Salary according to the RNABC Agree- 
ment. Please apply to: Mrs. A. Houghton. R.N., 
Director of Nursing. Fort SI. John General Hospital. 
9636-l00th Avenue. Fort St. John. British Colum- 
bia VIJ lY3. 

British Columbia 

General Duty Nurse for modern 3
-bed hospital 
located in southern B.C.'s Boundary Area with 
excellent recreation facilities. Salary and personnel 
policies in accordance with RNABC Comfortable 
Nurse's home. Apply: Director of Nursing. Bound- 
ary Hospital. Grand Forks. British Columbia. VOH 

General Dut} Registered Nunes required for lOS-bed 
accredited hospital in nonhwest B.C. Previous 
experience desirable Salary as per RNABC Con- 
tract with nonhern allowance. For further informa- 
tion, please contact: Director of Nursing. Kitimat 
General Hospital. 899 Lahakas Blvd. N., Kitimat. 
British Columbia V8C IE7. 

Permanent Part Time and Holiday Relief General 
Duty Rqiltered N...... preferably with one year's 
experience including obstetrics and geriatrics. Sal- 
ary. benefits as per RNABC contract. Small hospital 
in scenic West Kootenays-skiing, fishing, golfing, 
boating. hiking. swimming. Apply: Slocan Commun- 
ity Hospital and Health Care Society. Box 129. New 
Denver, British Columbia VOCJ ISO. 

Expenenced :l.urses (eligible for B.C Registration) 
required for full-time positions in our modern 
300-bed Extended Care Hospital located just thirty 
minutes from downto"n V dncouver. Salary and 
benefits according to RNABC contract. Applicanh 
may telephone 
-09ll to arrange for an interview. 
or write giving full particulars to: Personnel Direc- 
tor. Queen's Park Hospitdl. 31
 McBride Blvd., 
Ne" Westminster. British Columbia. VJL 5E8. 

Experienced !\ourses (B.C Registered) required for a 
newly expanded 463-bed acute. teaching. regional 
referral hospital located in the Fraser Valley. 20 
minutes by freeway from Vancouver. and within 
easy access of various recreational facilities. Excel- 
lent orientation and continuing education program- 
mes. Salary-I979 rates-$1305.00-$1
42.00 per 
month. Clinical areas include: Operating Room. Re- 
covery Room. Intensive Care. Coronary Care. 
Neonatal Intensive Care. Hemodialysis. Acute 
\ledicine. Surgery. Pediatrics. RehabIlitation and 
Emergency. Apply to: Employment Manager. Royal 
Columbian Hospital. 330 E. Columbia St.. New 
Westminster. British Columbia. V3L 3W7. 

GeDeral Duty RN's or Graduate 'liurses for 
Extended Care Unit located six miles from Dawson 
Creek. Residence accommodation available. Salary 
and personnel policies according 10 RNABC Apply: 
Director of Nursing. Pouce Coupe Community 
Hospital. Box 98. Pouce Coupe. British Columbia or 
call collect (604) 786- 

E"perirnced General Duty Nurses required for 
1300bed hospital. Basic Salary $ 1.30
.00-$ 1.
per month. Policies in accordance with RNABC 
Contract. Residence accommodation available. 
Apply in writing to: Director of Nursing. Powell 
River General Hospital. 
871 Arbutus Avenue. 
Powell River, British Columbia V8A 4S3. 

Registered Nurses required for permanent fulltime 
position at a l47-bed fully accredited regional acute 
care hospital in B.C Salary at 1979 RNABC rate 
plus northern living allowance. One year experience 
preferred. Apply: Director of Nursing. Prince 
Rupert Regional Hospital. 130
 Summit Avenue. 
Prince Rupert. British Columbia, VSJ 2A6. Tele- 
phone (collect) (604) 624-2171 Local 227. 

British Columbia 

General Dut} Nunes required for an dctive. IOJ-bed 
hospital. Positions available for experienced R.N's 
and recent Graduates in a variety of areas. RNABC 
Contract in effect. Accommodation available. Apply 
to: Director of Nursing. Mills Memorial Hospital. 
4720 Haugland Avenue. Terrace. British Columbia 
VSG 2W7. 

Expemocrd matemky, 1.C.U./C.c.U., IIDd Operat. 
Inll Room General Duty nunes required for IOJ-bed 
accredited hospital in Northern B.C Must be 
eligible for B.C. registration. Apply in writing to the: 
Director of Nurses. Mills Memorial Hospital. 4720 
Haugland Avenue. Terrace, British Columbia, VSG 

General Duty !\ourses required by an active 80-bed 
acute care and 40-bed extended care hospital located 
in the Canboo region of B.C's central interior. 
Year-round recreational activities in this fast grow- 
ing community. Applicanh eligible for B.C registra- 
tion preferred. Apply in writing to: The Director of 
Nursing. G.R. Baker Memorial Hospital. 
4J Front 
Street. Quesnel. British Columbia V2J 2K7. 

Registered Nuneø required immediately for perma- 
nent full time positions at IO-bed hospital in B.C 
Salary at 1978 RNABC rate plus nort
ern living 
allowance. Recognition of advanced or pnmary care 
education. One year experience preferred. Apply: 
Director of Nursing. Stewart General Hospital. Box 
8, Stewart, British Columbia, VOT IWO. Telephone: 
(604) 636-2221 Collect. 

Registered Nurses - Full-time and casual relief 
positions are available at the University of British 
Columbia. Health Sciences Centre. Extended Care 
Unit. The 12 hour shift, the problem oriented record 
charting system, and emphasis on maintaining a 
normal and reality based clinical environment. and 
an interprofessional approach to management are 
some of the features offered by the Extended Care 
Unit. Interested applicants may enquire by calling 
228-6764 or 228-2648. Positions are open to both 
male and female applicants. 

Lnhersit} of \ictoria, School of 'l/ursing. Apphca- 
tions are invited for positions On the faculty of the 
School of Nursing. University of Victoria. The 
School offers a two-year post-R.N. programme 
leading to a B.Sc.N. and plans to develop both a 
basic and a master's programme. Quahfications: 
Master's degree required. doctorate preferred. Ex- 
perience in university teaching an asset. Apply to: 
Director. School of Nursing. University of Victoria. 
P.O. Box 1700, Victoria. British Columbia V8W 


Challrnging Carff'r Opportuni1
 for Rt-gi...lert'd 'urses in 
("anada's 'ol1h - .t\ IOU bed etCute Ca.-c ho'plt.1I in Nonhern 
\1etmtobd which services Thompson and several small 
communities m Ihe ,uITounding a'-Cet has immediate vacan- 
cle!) in Pedialrics. Medlcme/Su.-,gc.-}. Ohstelncs dOO C.-itical 
Ca.-c This opportumt) will apreal to nur'c.-. who want to 
mcrea<iii.e their ex"ting ...kllis or de...elop new skill... through our 
ivc inservlce progretm" Metny of our nur'e<iii. ha\-e 
become experienced in flight nursmg Candldate
 mu!)t he 
eligible for provincial reglstralion as acti\-e practlcmg 
members We offer dl1 excellent range of benefit.... mcluding 
free.denlal plan. accident. health and group life insurance. 
Salary range IS S 1.07t< - S I. 140 per month dependent on 
qualifications and cxpenence plu"" a rcmotcne

Apply m wnting or phone: Mr. R.t. Irvinc. Director of 
Personnel. Thomp...on General Ho
pital. Thomr
on. \1etn- 
,'ob.. R8N OR8 Phone: 1

Head Nurse - Operating 

Required for a 222 bed acute general 
hospital. The operating room consists of 
4 theatres and one cysto room with a 
staff complement of 22. 

Applicants must have demonstrated 
leadership and administrative skills, 
B.Sc.N. or post graduate education in 
O.R. preferred. 

Qualified applicants are invited to submit 
their resumes to: 

l'!iOnnel Director 
Plummer Memorial Public Hospital 
969 Queen Street East 
Sault Ste. Marie, Ontario 
PfiA 2C4 

Port Saunders Hospital 
Port Saunders, Newfoundland 
Registered Nurses 
commencing April 1980 through to 
September 1980. 
Applicants must be registered or eligible 
for registration with the Association of 
Registered Nurses of Newfoundland. 

Salary scale: $\3,923.00-$16,819.00. 

Please forward application, curriculum 
vitae and references to: 

Mrs. Madge PIke 
Director of Nursing 
FUn Saunders Hospital 
FUrt Saunders, Newfoundland 

Operating Room- 
Registered Nurses 

The Kentville Hospital 
Association requires staff nurses 
with experience and/or a post 
graduate course in operating 
room techniques. 

Please send complete resume to: 

Director of Personnel 
Kentville Hospital Association 
186 Park Street 
Kentville, N. S. 
B4N IM7 

Registered Nurses 
Registered Nursing 
Openings currently exist in a 788 
bed hospital specializing in 
convalescent, long-term 
rehabilitation and chronic care 
patients. Easily accessible by public 
transit, day care facilities available. 
Applicants must be prepared to 
work two shifts. 

rsonnel Department 
The Riverdale Hospital 
14St. Matthews Road 
Toronto, Ontario 
M4M 2B5 
461-8251 Ext.292 

University of British Columbia 
Health Sciences Centre Hospital 
Extended Care Unit requires 
Clinical Nursing Consultant 
- Education (Staff Nurse III) 

Reporting to the Director ofNur1ilnl. plans 
and imp1cmcnts orientation and on-Ioing 
in-service prOJTams for nursing and other staff' 
members. coordinates pre-admission 
assessment acti
ities. provides direct palienl 
care to sdcclcd patients as arranJCd. 
racilitates clinical nursmg re
participates In School of Nursing activltlCS an 
thc unit as requested. repn:sent
 E.C. U. in 
Nursing Education areas and maintains an 
effective wortmg relationship with nursing and 
other health þrofes
ionals. Requires Mastcn 
gree in Nursing or NUr1iing Education. 
registRttcn with the RNABC. evid
ncc or 
clinical competence in the ure of 
elder1yfdisabted plUicnt
. demonstrated 
to pro.aram planning. Imp1emcntation and 
evaJuatlOn and successful work experience In 
clinical nursing and nursing education. Salary 
range S I 
oo - S 1772 per month plus differentia] for dearrc. 
Applicants should 
ubmit detailed resume to: 
Coord-tutor Dr Hoapllal Emplo)'lDftt 
He.1th Sdmcn CIfDIre HoItIil:aJ 
llalwnlty or Brit'" Columbli. 
Vaacouwr.8.C. v6T IW5 

itlon open to both male and rcmaJe applicants 

Regina General Hospital 
Registered Nurses & New 
Come Join Our Staff! 

Interesting challenges are experienced in our 
acute care 483 bed hospital. We have started a 
regeneration program to replace ex isting 
facilities. These new facilities wiJI be eqjoyed 
in the near future. 
. Salary in accordance with Union Agreement 
. Progressive Personnel Policies 
. Paid planned programs in: 
General Orientation 
Coronary Care 
Intensive Care 
Other specialty areaS 
. Continuing In-Service Education 
. Friendly working atmosphere 
Apply to: 
Personnel Servi
Regina General Hospital 
Rqlna, Saskatchewan S4P OW5 

- - -- 

New Brunswick 

DIrettor of Nunla. required for a 6O-bed Nursina 
Home facility (N .B. Reaistration or eligible) and 
must be bilinauaI and have extensive experience in a 
senior nursing administrative position. Apply to: 
Administrator, Grand Falls Manor Inc., P.O. Box 
2000, Grand Falls, New Brunswick EOJ I MO. 

Faculty _mllen required with teaching and clinical 
experience for an integrated undergraduate program. 
(I) Medical-Suraical Nursing, to work with team 
who teach seniors in an acute care setting; (2) 
Maternal and Child Health Nursing, to teach second 
year students in pediatrics, and third year students in 
the Nursery; (3) Community Nursing, to teach 
freshman students in the classroom, with observa- 
tions in the community in the first term and clinical 
teaching in geriatrics in the second term. Directing 
community experiences for second year students. 
Applicants should be able to qualify for the rank of 
Assistant or Associate Professor. Master's degree 
essential. Salary in accordance with qualifications 
and experience. Apply with curriculum vitae and 
names of referees to: Dean I. leckie, Faculty of 
Nursing, University of New Brunswick, P.O. Box 
4400, Fredericton, New Brunswick E3B 5A3. 


The GenernJ Hospital-A newly opened teaching 
hospital located in historic 5t. John's offers to 
RqieUred Nunes who seek specialized and profes. 
sional growth a twenty-four week course of integ- 
rated academic and clinical e)(perience in the 
following: Critical Care Nursing; Neurosciences 
Nursing; Operating Room Nursing. Applications 
now being accepted for September 1980. Please 
contact: Director, Staff Development &. Training 
Dept., The General Hospital, Prince Philip Drive, 
St. John's, Newfoundland AIB 3V6. 

Northwest Territories 

The Stanton Yellowknife Hospital. a 72-hed accre. 
dited. acute care hospital requires registered nurses to 
work in medical, surgical. pediatnc, obstetrical or 
operating room areas. Excellent orientation and 
inservice education. Some furnished accommoda- 
tion available. Apply: Assistant Administrator- 
Nursing, Stanton Yellowknife Hospital. Bo)( 10. 
Yellowknife, N.W.T., XIA2Nl. 


RN, GRAD or RNA, 5'6" or over and strong, 
without dependents. non-smoker. for IS5 lb. hand- 
icapped retired eucutive with stroke. Able to 
transfer patient to wheelchair. live in 1/2 yr. in 
Toronto and 1/2 yr. in Miami. Wages: $200.00 to 
$275.00 wkly. NET plus $90.00 wkly. bonus on most 
weeks in Miami. Write: M.D.C., 3532 Eglinton 
Avenue West. Toronto. Ontario, M6M IV6. 

Applications are nOW being accepted by the Ontario 
Society for Crippled Children for Registered Nurses, 
Graduate Nurses and Registered Nursing Assistants 
for their Resident Summer Camps located near 
Collingwood, Port Colborne. Perth. Kirkland lake 
and London. Ten weeks - mid June to late August, 
1980. Various positions available - Supervisory, 
Assistant supervisory, and general cabin respon- 
sibilities. Contact: Camping and Recreation De- 
partment. 350 Rumsey Road. Toronto, Ontario M4G 
IRS. (416) 425-6220. ext. 242. 


Camp Nunes required for children's summer camp 
in beautiful Quebec laurentians. Mid-June to end of 
August. Resident M.D. Contact: Mr. Herb Finkel- 
berg. Director of Camp BONdi B'Rjth. 5151 Cote SI. 
Catherine Rd.. Suite 203. Montreal. Quebec H3W 
I M6. or telephone (514) 735-3669. 


DIndor of Nunml - Inviting applications from 
Nurses. This will be an opportunity for a Nurse who 
II lacel'ftled In maaeae_at. Related experience and 
education will be considered. Apply in confidence 
to: Administrator, Eastend Union Hospital, Eas- 
tend, Saskatchewan SON OTO. or Cdll collect (3061 

Two Rqletered Nunes are needed for l2-bed 
hospital 430 miles northwest of Saskatoon. Wages 
and benefits as per SUN contract. Trailers available 
as living accommodations. Apply to: Sister Helen 
ÐesmanlÍs. Director of Nursing. St. Martin's Hospi- 
tal, La Loche, Saskatchewan SOM IGO. 

Four R.N.'. urgently needed for 8 bed modern 
hospital in southern Sask. Must be eligible for 
S.R.N.A. registration. Please apply to: Administra- 
tion, Beechy Union Hospital. Box 68. Beechy, 
Saskatchewan SOL OCO or Telephone (306) 859- 
-2118. . 

United States 

Total patient care with all licensed personnel is our 
goal! StaIr RN. currently interviewing for part-time 
and fuU-time positions. Full service, except psych. 
progressive 156-bed accredited acute general hospi- 
tal. Located within 60 minutes from LA, the ocean. 
mtns.. and the desert. Orientation and staff de- 
velopment programs. CEUs provider number 
Park view Community Hospital. 3865 Jackson Street, 
Riverside. California 92503. Write or call collect 
714-688-2211 ext. 217. Betty Van Aernam. Director 
of Nursing. 

R!II'S - Our Florida hospitals need you! Join the 
many Canadian RN's who are currently el\ÍOying 
Florida's Gulf Coast beaches. sun. and exciting 
recreational activities. We will provide work visas. 
help you locate a position, find housing, and arrange 
your relocation. No FHs! Call or write: Medical 
Recruiters of America. 1211 N. Westshore Blvd., 
Suite 205. Tampa. Florida 33607 -(813) 872-0202. 

Appraise our MiamI Hospital - What can Victoria 
Hospital offer you? We can give you a modern 
300-bed progressive. acute care hospital as a 
stimulating work environment. We offer excellent 
salaries. benefits, CEU's, tuition refunds and reloca- 
tion assistance. For pleasure. Miami has great 
beaches, boating, dining. discos, tennis, golf, snor- 
keling. etc. Our Hospital also has apartments 
available. Want to learn more? Call Ms. McDonald, 
R.N.. per.>on-to-person, collect at (05)772-3682, or 
write Nur.>e Recruiter. 800 N. W. 62nd St., Suite 510, 
Ft. Lauderdale. Fla. 33309. 

Before accepting any 
position in the U.S.A. 
We Can Offer You: 
A) SelectIOn of hospitals Ihroughout 
the US.A 
B) ExtenSive information regarding 
Hospital-- Area. Cost of Living. etc 
C) Complele Licensure and Visa Service 
Our Services to you are at 
absolutely no fee to you. 

P.O. Box 1133 Great Neck. N.Y. 11023 
(516) 487-2818 
Our 23rd Year of World Wide Service 

United States 

CaUfomla - Sometimes you have to go a long way 
to find home. But. The White Memorial Medical 
Center in Los Angeles, California. makes it all 
worthwhile. The White is a 377-bed acute care 
teaching medical center with an open invitation to 
dedicated RN's. We'll challenge your mind and offer 
you the opportunity to develop and continue your 
professional growth. We will pay your one-way 
transportation. offer free meals for one month and all 
lodging for three months in our nurses residence and 
provide your work visa. Call collect or write: Ken 
Hoover, Assistant Personnel Director, 1720 Brook- 
lyn Avenue, Los Angeles. California 90033 (213) 
268-5000, ext. 1680. 

Try Canada's 
This Summer 

Découvrez les 
du Canada cet étéo 

JOin the team providing health 
care to the residents of the 
Northwest T erritones. Medical 
Services. Northwest Territories 
Region will be offenng a number 
of term positions lor qualified and 
expenenced nurses. 

Positions are available at nursing 
stations, health centres and 
hospllals for the penod. May 
through September. 
Knowledge of tre English 
language IS essential 

For more Information wnte to: 
Nursing Advisor, 
Human Resource Planning, 
Medical Services Branch, 
Health and Welfare Canada, 
Room 1972, 
Jeanne Mance Building. 
Tunney's Pasture, 
Ottawa, Ontario K1A OL3 
NOTE. Permanent positions are 
also available. 

Open to both men and women 



Health and Welfare 

Santé el Blen-ëlre social 


The r.."....I.n .....r_ 

United States 

norlcle NunIDJ Opportualtlee - MRA i. recruiting 
ReJistered Nunes and recent Graduates for hospital 
positions in cities such as Tampa, St. Petenburg, 
and Sarasota on the West Coast; Miami, Ft. 
Lauderdale and West Palm Beach on the East Coast. 
If you are considering a move to sunny Florida. 
contact our Nurse Recruiter for assistance in 
selecting the riilht hospital and city for you. We will 
provide complete Work Visa and State Licensure 
information and offer relocation hints. There is no 
placement fee to you. Write or call Meclkal 
Recndtenof "-rice, lac. (For WestCoast\121 IN. 
West.hore Blvd.. Suite 205, Tampa. FI. 33607 (813) 
87H)202; (For East Coast) 800 N. W. 62nd St.. Suite 
510, Ft. Lauderdale, FI. 33309 (305) 772-3680. 












"'-';:: -- - 

JOlgnez-vous à I'équlpe médicale 
qUI sOigne les habitanls des 
T erritoires du Nord-ouest La 
direction des Services médlcaux 
réglon des T erritolres du 
Nord-ouest, offre des postes 
d"infirmiéres dipl6mées, pour une 
pénode déterminée. 

Les postes offerts se trouvent 
dans des posies de SOInS 
mflrmiers, des centres sanitalres 
ou des h6pitaux; la période de 
travail va de mai à septembre. 

La connalssance de I'anglals esl 

Pour de plus am pies 
renselgnements, prière d'écnre à 
I'adresse suivante: 
Conseillère en soins infirmiers. 
planification des ressources 
Direction générale des services 
Santé et Bien-être social Canada 
Pièce 1972, 
Immeuble Jeanne Mance 
Parc Tunney 
Ottawa, Ontario K 1 A OL3 

REMARQUE Des pastes 
permanents sont également 
Appel de candidatures mixtes 


Nursing in 
the Sunny Palm Beaches 

Picture yourself in the sunny Palm Beaches 
working at the most prestigious hospital in 
Florida. Good Samaritan Hospital has 
maintained the tradition of being the first in the 
latest hospital services and facilities. Our good 
name and outstanding history attest to our 
A 326 bed, J.C.A.H. accredited ho'pital 
offering attracti ve salaries and benefits 

. Active in-service orientation 
. Continuing educational programs 
. 37 1/2 hour week 
. 5 day week 
. No shift rotation 
. Education and experience 
. Fully paid Blue Cross/Blue Shield 
. Shift differential and other employee 
. Seasonal employment welcome 
. . Patient-mix 90% under age 65 

We will sponsor the appropriate employment 
Visa for qualified applicants. Attractive 
efficiency apanments available at far below 
commercial rates. overlooking the beautiful 
Lake Wonh and located across the boulevard 
from the hospital. 


Director of Personnel (3051 655-5511 
Good Samaritan Hospital 
Flagler Drive at Palm Beach Lakes Blvd. 
P.O. Box 3166 
West Palm Beach, Fla. 33402 

Offers R.N. 's 

and $500 Initial LIVING EXPENSES on a Loan Basis. 
Alter One Vear's Service, This Loan Will be Cancelled 

MI American Medical I/lternational Inc. 

. Now A.M.!. II Recruiting R.N. '110. Hospilals in Tells. 
Immetllate Oplnlngl. Sallry Range SttoOO 10 S16,500 per Year. 

. You can enjoy nursIng In General Medlc,"e. Surgerv. Ice 
eeu, Pediatrics and Obstetncs 
. A M I provlOes an excellent onentallOn program. 
In-service traolllng 

. U.S. Nurse Recruiter . 
. P.O. Box 17778, Los Angeles, Calif. 90017 . 
I . WIthout obligatIon. please send me more . 
I nlormatlon and an ApplicatIon Form I 
. NAME_________ ___ 
. ADDRESS____ ____ ___I 
. CITY_ _ -- ST.___lIP ___I 
TELEPHONE(__)______ ___ 
. LlCENSES:_______ __I 
. SPECIALTY:_ ___ _ _ _ ---I 

lI" .....rr" J!l1UI 

United States 

RN_Immediate openings in California- 
Florida-Texas-Maryland-Virginia and many other 
States - if you are experienced or a recent Graduate 
Nurse we can offer you positions with excellent 
salaries up to $ 16,000 per year plus all benefits. Not 
only are there no fees to you whatsoever for placing 
you, but we also provide complete Visa and 
Licensure assistance at also no cost to you. Write 
immediately for our application even if there are 
other areas of the U.S. that you are interested in. We 
wtll call you upon receipt of your application in order 
to arrange for hospital interviews. You can call us 
collect if you are an RN who is licensed by 
examination in Canada or a recent graduate from any 
Canadian School of Nursing. Windsor Nurse Place- 
ment Service, P.O. Box 1133, Great Neck, New 
York 11023, (516)487-28/8). 
"Our 23rd Year of World Wide Service" 

The Best Location in the Nation-The world- 
renowned Cleveland Clinic Hospital is a progres- 
sive, 1030-bed acute care teaching facility committed 
to excellence in patient care. Starr Nune positions 
are currently available in several of our ICU's and 30 
depanmentalized medical/surgical and specialty di- 
visions. Staning salary range is $14,789 to $17,056, 
plus $1248/year ICU differential and premium shift 
differential, comprehensive employee benefits and 
an individualized 7 week orientation. We will 
sponsor the appropriate employment visa for qual- 
ified applicants. For funher information contact: 
Director-Nurse Recruitment. The Cleveland Clinic 
Hospital. 9500 Euclid Avenue, Cleveland, Ohio 
44106 (4 hours drive from Buffalo, N.Y.); or call 
collect 216-444-5865. 

Come to Texas - Baptist Hospital of Southeast 
Texas is a 400-bed growth oriented organization 
looking for a few good R.N.'s. We feel that we can 
offer you the challenge and opponunity to develop 
and continue your professional growth. We are 
located in Beaumont, a city of 150,000 with a small 
town atmosphere but the convenience of the large 
city. We're 30 minutes from the Gulf of Mexico and 
surrounded by beautiful trees and inland lakes. 
Baptist Hospital has a progress salary plan plus a 
liberal fringe package. We will provide your immig- 
ration paperwork cost plus aiñare to relocate. For 
additional information, contact: Personnel Ad- 
ministration. Baptist Hospital of Southeast Texas, 
Inc., P.O. Drawer 1591, Beaumont, Texas 77704. An 
amrmaUve action employer. 

Nurses - RNs - A choice of locations with 
emphasis On the Sunbell. You must be licensed by 
examination in Canada. We prepare Visa forms and 
provide assistance with licensure at no cost to you. 
Write for a free job market survey Or call collect 
(713) 789-1550. Marilyn Blaker, Medex, 5805 
Richmond. Houston. Texas 77057. All fees employer 

Nurse - Mldw/vlS - Northern Africa & Central 
Amerka: Bachelor's Degree, Midwifery Cenifica- 
tion, 5 + years' experience and an interest in clinical 
and classroom teaching. Project HOPE provides 
excellent benefits, travel. shipping and storage, 
salary commensurate with experience. Shon and 
long term positions available. Send resume to: 
Personnel Oepanment, Project HOPE, Millwood, 
Virginia 22646. E.O.E. 


Adventure Holidays: Camping Safaris. Overland 
Expeditions and Fun Experiences. We offer trips 
from one week to 3 months in: Canada, USA, 
Europe. Africa. Asia. South and Central America, 
Australia. New Zealand and the Carihbean. For free 
catalogue. apply to: Goway Travel. 53 Yonge 51.. 
Suite 101. Toronto. Ontario M5E lB. Phone: 
416-863-0799. Telex: 06-219621. 

Electrolysis - Successful Electrolysis Practice for 
Sale. 6 months specialized included. Write or phone: 
Margot Rivard, -1396 SI. Catherine Street West, 
Suite 221, Montreal, Quebec, H3G lP9. Telephone: 
(514) 861-1952. 

_:rh,r.n.rtl_., ......... 

Brandon General Hospital 
School of Nursing 
Program Co-ordinator 
- July 7, 1980 
- August 1, 1980 

Applications are invited for these 
Faculty Positions in a Hospital based 
two-year diploma nursing program which 
uses an individualized teaching-learning 

Eligible for M.A.R.N. Registration, 
Bachelor's Degree in Nursing and a 
minimum of one year's clinical practice 
experience required for teacher 

Master's Degree in Nursing with 
appropriate experience in program 
planning, curriculum development and 
teaching preferred for Program 
Co-ordinator position. 

Apply sending resume to: 

Mrs. Shirley J. Paine 
Director of Nursing Education 
School of Nursing 
Brandon General Hospital 
150 McTavish Ave. E. 
Brandon, Manitoba 
R7 A 283 

Head Nurse 

Neonatal Intensive Care Unit 

The Victoria General Hospital, a 422-bed 
community hospital invites applications from 
B.C. Registered Nurses for the challenging 
position of Head Nurse - Neonatal Intensive 
Care Unit. 

The hospital is currently involved in a total 
rebuilding programme and upon completion of 
the new facility in 1982 will be the m,yor 
referral hospital for Obstetrics for the Victoria 

Reponing to the Director of Patient Care 
Services, the Head Nurse assumes 
responsibility for patient care. staffing, and 
operating efficiency of the U nit. The Head 
Nurse, in cooperation with other Obstetrical 
staff, will also be involved in developing 
procedures, staffing requirements, etc. for the 
new facility. 

Commitment to family-centered obstetrical 
care is essential. Post-graduate training in 
Neonatal Intensive Care or equivalent 
experience and demonstrated leadership 
ability required. Teaching experience an asset 

Apply to: 

Personnel Manager 
Vktorla General Hospital 
841 Falrllrld Road 
Vktorla, B.C. 
V8V JB6 


It's The Hospital of the Futurel 


Central Supply - Pharmacy 
Dietary - Medical Records 
The emphasis is on NURSING at Holy Cross 
Hospital, a 259-bed acute care facility located just 
north of Los Angeles. Call us collect for full 
information on The Hospital of the Future. 
Contact Marian Williams, Nurse Recruiter, 
at (213) 365-8051, ext. 1488 

Holy Cross Hospital 
15031 Rinaldi Street 
Mission Hills, Ca. 91345 
Equal Opportunity Employer M/F 

. . 

Nursing.. . 

Graduate of 
AA_ BS_Dip_Yr 
Area of Interest 

CAN 380 

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Exploring the Many 
Faces of Opportunity 


Opportunity wears many faces at 
Santa Monoca HospItal MedIcal Center In 
Southern California It can be the excite- 
ment and challenge of working as part of 
our Operating Room or Crotlcal Care teams 
It can also be In the achIevement of your 
goals as you begin to playa more actIve 
role In management and/or supervIsIon 
However, opportunities expand be- 
yond your professional life In Southern Cal- 
IfornIa The total scope of the' active life IS 
virtually unlimIted from wide, sunny beaches 
to near- by winter slopes the opportunotles 
are here 
If you would like more information 
about exploring the many opportunotles now avail- 
able 10 you. please forward the below coupon 
Who knows. you may fond a new defmltlon 
for "opportunity" 

,+t j 
\ ....:'. 
7 + .'C 



.. :1:,,\ 

@ Santa Monica Hospital 
Medical Center 
t225 15th S'-. Santa MonIca. CA 90404 
 (213) 451-15t1 Ex'- 2537 


An EQual Opportunllv Emplover M F CN-3 



...is a short drive 
' Ba

Searching for a place where your spare time can be a true source of 
adventure? This one-tIme Spanish seaport will capture your spint wIth 
scores of hlstoncal sites as well as easy access to the wonders ofthe GIant 
Redwoods It's one ofthe fascinating places you'll find, a short drove from 
Stanford Unoversity Medical Center 
YOu will also find 'tomorrow's" nursing today in an exciting teaching 
hospital where non-clinical personnel handle admlnostrativeand support 
tasks so you can concentrate on progressive nursing You can apply new 
techniques, partIcipate in research and work with leading authorities in 
every medIcal specIalty 
We'd like you to know more about our career development programs and 
our excellent compensation package which includes an innovative time- 
off program. For additional informallon, send the COupOn to Nurse 
Recruiter, Personnel Department. Stanford University HospItal, 
Stanford, CA 94305. Or call collect to (415) 497-7330 For immediate 
consideration, send your resume and salary requirements We are an 
affirmative actIon, equal opportunIty employer, male and female 


Stanford l11Ï\l''fsity 

 ledical Center 

Th.. r....., '11" Nllr.,. 

....r,.h 1cutn 

Foothills Hospital, Calgary, 
AI berta 

Advanced N eurological- 
Neurosurgical Nursing for 
Graduate Nurses 

A five month clinical and academic 
program offered by The Department of 
Nursing Service and The Division of 
Neurosurgery (Department of Surgery) 

Beginning: March, September 

Limited to 8 participants 
Applications now being accepted 

For further information, please write to: 
Co-ordinator of In-service Education 
F oothiIls Hospital 
140329 St. N.W. Calgary, Alberta 

Waterford Hospital 
Career Opportunities For 
Registered Nurses 

fhe Walcnord Hospital, a fully .accredited 400 
tied Psychlatnc Institution. affiliated wuh 
Memorial Univcrslt) School orNur
Medical School. ha<li opemngs for Rrgl
Nurse\ ;n all \crvicc\. including ncW. 
cxpanded. él.nd acutC' care services 
An oricolahon program IS offered. 
Salary IS on the scale ofll;!.04ft - 14. 
annum ^ Psychiatnc Service .A:.llowí\ncc of 
S I. '29 pcr annum i'i av.ulablc ni addition to 
basIc 'alar}. 80th \alar)' .and '!iIlJowdncc 
presently under feview 
The Hospital is close to all aOlcmllC'!!. 
shoppmg. tran!!.portallon and reereallon 
 a"adable in Ho"pilal 
Resl<knee al nominal eosl. 
Apphealion\ Iß wnlmg should be addre"sed 10 
the umJcr"lgncd' 
Pt-nonncl Direclor 
\htrrford H06pital 
,,"'atuford 8rid
St. John's. '1rwfoundland 
AtE 4JR 
Telephone '\umber: (709, 368-6061. rxl. .141 

IntemauondlGrenfell Associdtion 
Registered I'<urses, Public Health 
Nurses and Nurw-Midwives 
for Northern Newfoundland and Ldbrador 
The International Grenfell A!otsociation 
provides Medical ServIces in Northern 
Newfoundland and Labrador. It "affs 
four ho,pitdls, seventeen nur"iing 
stdtions dnd ffidny public health umt,_ 
Our main hospital is a I 
o bed accredited 
hospit.,] situated in scenic SI. Anthony. 
Newfoundldnd. Active treatment i'i 
Cd !Tied on in Surgery. PsychIatry. 
Medicine. Pediatrics. OBS/GYN. and 
Orientation and active In
Program provided for staff. Sdldry based 
on government scale\: 37 1/2 hr\_ per 
week. Rotating shifts. Excellent 
personnel benefits ,nclude liberal 
vacation and "iick leave. Accommodation 
dvailable. Return airfare paid on a 
completion of dOne yedr "iervice. 
Apply to: 
Scon Smith 
Personnel Director 
Curtis \1emorial Hospital 
International (;renrell A!o..\OCiaUon 
SI. Anthon
ewroundJand AOK 4S0 

Intensive Care Nurses 

300 bed Accredited general 
hospital in Vancouverrequires 
full-time R.N .s for 4 bed loCo U. 
Candidates should be eligible for 
registration with the RNABC. 
Previous I.C.U. experience 
req ui red. 

Please apply in writing to: 

Employee Relations Department 
Mount Saint Joseph Hospital 
3080 Prince Edward Street 
Vancouver, B.C. vsr 3N4 


McMaster Universit) 
Educational Program 
For Nurses In 
Primary Care 
McMaster Univer,;ity School ofNurs- 
ing in conjunction with the School of 
Medicine. offers a program for regis- 
tered nurses employed in primary 
care seuings who are willing to 
assume a redefined rule in the primary 
health care delivery team. 

Requirements Current Canadian Regist- 
ration. Preceptorship from a medical 
practitioner. At least one year of work 
experience. preferably in primary Care. 

For further information write to: 
Mona Callin. Director 
Educational Program for Nurses 
in Primary Care 
I'aculty of Health Sciences 
McMaster University 
Hamilton. Ontario L8S 4J9 

Prince George 
Regional Hospital 

Positions available for experienced nurses or 
nurses interested in developing their skills in 
specialty nursing - Operating Room, 
ICU/CCU. Neonatology Nursing. Must be 
eligible for B.C. Registration. 

. Well developed orientation program 
. lnservice Education 
. Expanding Operating Room and Obstetrical 
. 10 bed ICU/CCU 

Prince George Regional Hospital is a 340 bed 
acute regional referral hospital with a 75 bed 
extended care unit and ha. a planned program 
of expansion. 

For further information contact the: 
Personnel Depanment 
Prince George Regional Hospital 
2000 - 15th A venue 
Prince George, British Columbia 
V2M IS2 


Royal Jubilee Hospital 
Victoria, B. C. 

Applications are invited from Registered 
Nurses or those eligib
 for B.C. Registration 
with recent nursing experience. 

Positions are available in all services of this 
950 bed accredited hospital which includes 
Acute and Specialty Care, Obstetrics and 
Paediatrics, Psychiatry and Extended Care for 
Full Time, Part Time and Casual Employment. 

Benefits in accordance with R.N.A.B.C. 

Please send resume to; 

DIrector of Nunlng 
Roylll Jubilee Hospital 
1900 Fort St. 
Victoria, B. C. 
V8R lJ8 

Registered Nurses 

Ful\ and pan-time vacancies in a 
new expanding hospital with 
progressive programmes in long 
tenn care, rehabilitation and 

Must be eligible for Ontario 

Write to: 

Assistant Director of Nursing 
West Park Hospital 
82 Buttonwood A venue 
Toronto, Ontario 
M6M 2.15 


CUSO has openings in Africa, Papua New 
Guinea and Latin America for nurses with: 
Public Health 
SSc and Master Degrees 
Qualifications: All except the midwifery 
positions require Canadian qualifications. 
Contract: 2 years. 
Salary: Low by Canadian standards but 
sufficient for an adequate lifestyle. Couples 
will be considered if there are positions for 
both partners. For more information, write: 
CUSO Health 0-1 Program 
151 Slater Street 
Ottawa, Ontario 
K1P 5H5 

University of British Columbia 
Health Sciences Centre 


Registered Nurses 

Opportunities for nurses interested in working as 
members of the interprofessional team in the new 240 bed 
Acute Care Unit, of the H.S.C. on the U. B.c. campus. 

Positions available in: 

· Operating Room Suite 
· Intensive/Coronary Care 
. Medicine 
. Surgery 
. Emergency 

Nurses must be registered or eligible for registration with 

Applicants should apply in writing with detailed resume 

Coordinator of Professional Emplo) ment 
Health Sciences Centre 
L'niversity of British Columbia 
Vancouver. B.C. 

Positions open to both female and male applicanbo 

Nursing Unit Coordinator 
Required B3' The Thompson 
General Hospital, 
Thompson, Manitoba 

The Thompson General is a fully accredited 
100 bed acute care hospital located in a modem 
community of 18,000 in North Central 

The successful applicant will be given the 
responsibility of planning, organizing and 
directing the activities of a46 bed 
Medical/Surgical Unit. 

Applicants must be eligible for registration 
with M.A.R.N. Preference will be given to 
those with Administrative traming and/or 

The salary range for this position is $ I 7 ,600 - 
$22,200 per year. Other benefits include Group 
Life, Pension Plan, free dental program, 
income protection and remoteness allowance. 

Those interested are asked to apply, in 
confidence, giving details as to experience, 
education and references to - 

Mr. R.L. Jnine 
Director of 
Thompson General Hoopital 
Thompson, Manitoba RSN OC8 

Telephone (264) 677-23111 



Applications are invited for positions at Alberta Hospital, 
Edmonton, a 650 bed active treatment psychiatric hospital, 
located 4 km. outside of Edmonton. 
Successful candidates must be graduates from a recognized 
School of Nursing and eligible for registration in their 
professional association; willing to work shifts. Vacancies exist 
in Admissions, Forensic. Rehabilitation, and Geriatric Services. 
Note: Transportation is available to and from Edmonton. 
Accommodation is available in the Staff Residence. 

Salary $1,229- $1,445 per month (Starting salary based on 
experience and education) 

Competition #9184-9 
This competition will remain open until a suitable candidate has 
been selected. 

Qualified persons are invited to phone, write or submit 
applications to: 

Personnel Administrator 
Alberta Hospital, Edmonton 
Box 3Ø7, Edmonton, Alberta 
TSJ 2.17 
Telephone: (403) 973-2213 

seeks a 

The University of Alberta 

Dean of Nursing 

Candidate should have earned doctoral 
degree, demonstrated scholarship, 
professional achievement and 
competence in administration. 

Salary commensurate with qualifications 
and experience. 

Nursing is one oftive Health Science 
Faculties and offers Baccalaureate and 
Master's level programs. 

Starting date: July I, 1980. Applications 
and nominations should be received 
before April 11th, 1980 and should be 
sent to: 

Dr. R. G. Baldwin 
Vice-President (Academic) 
The Universit
 of Alberta 
Edmonton. Alberta 
T6G 2.19 

The University of Alberta is an equal 
opportunities employer. 

Th..a ,.........,11... ......__ 

Nursing Instructors 
Located in the geographic centre of 
beautiful British Columbia the College of 
New Caledonia serves a region of 
120.000 people. Applications are invited 
for positions of full-time Nursing Faculty 
at the College of New Caledonia for the 
1980-81 academic year. 
Qualifications: Applicants must have a 
Baccalaureate Degree and must be 
registered or eligible for registration in 
British Columbia. Preferably applicants 
will have two years of nursing practice 
and teaching experience. In particular 
Medical-Surgical Nursing experience is 
Salary: $18,050.00 to $32,450.00 per 
annum. Placement dependent upon 
qualifications. Relocation assistance is 
also available. 
Letters of application with the names of 
three references should be submitted to: 
L. Winthrope 
Personnel ()flf1cer 
College of New Caledonia 
333Ø - 22nd A venue 
Prince George, B.C. 
V2N 11'8 
Phone enquiries to the Personnel Officer 

Registered Nurses 

Come to work in scenic Comer Brook! 

Registered nurses are needed for this 350 bed Regional General 
Hospital, with detached 60 bed Special Care Unit, serving the 
West Coast of Newfoundland. 

The hospital offers good fringe benefits such as four weeks 
annual vacation and eight statutory holidays plus birthday 
holiday. In addition there is a hospital pension plan and a group 
insurance plan for all permanent employees. 

Accommodation and assistance with transportation is available. 

Negotiated Salary Scale: 

1 January, 1979 - $12,771.00 - 15,429.00 
I January, 1980 - $13,410.00 - 16,199.00 
(Contract not yet signed) 

Service Credits recognized. 

Interested applicanlS apply to: 

Mrs. Shirley M. Dunphy 
Director of Personnel 
Western Memorial Regional Hospital 
P.O. Box 2005 
Corner Brook, Newfoundland 
A2H 6J7 

Registered Nurses 

1200 hed ho....pital adjacent to U niver....ity of 
,.\Iherta campl..... offer.... emplovment in 
medicine, surgery, pediatrics, 
orthopaedics, obstetrics, psychiatry, 
rehabilitation and extended care including: 

. I nten....i\ e care 
. Coronary oh....ervation unit 
. Cardiova....cular ....urger
. Burn.... and pla....tic.... 
. Neonatal inten....ivc care 
. Rcnal dialy....i.... 
. Ncuro-....urgcr} 

Planned Orientation and In-Service Education Programs. 
Post Graduate Clinical Courses in Cardiovascular- 
Intensive Care Nursing and Operating Room Nursing. 

Rl'uuitml'nt Oflicer - '\ur,ing 
t ni\l'r,it
 of .\Ilwrta lIo"'pital 

O - 1 12th Strl't.'t 
Edmonton, .\Ilwrta 
T6l; 2ß7 

.... Ian 

Registered Nurses 

Planning your summer vacation? 

Then by aU means, include a visit to beautiful 
Vancouver in your plans. And while you're here, 
drop in and discuss your nursing career 
opportunities at Shaughnessy Hospital, an I tOO bed 
multi-level community teaching hospital. 

We have full-time, part-time and float positions 
available as well as a 2 week orientation for RN's 
who wish to work on a casual basis only. 

When you're in Vancouver please call: 

Jane Mann 
Employee Relations 
Shaughnessy Hospital 
4500 Oak Street 
Vancouver, B.C. 
V6H 3Nl 
(604) 876-6767 


University of 
Alberta Hospital 

Edmonton. Alberta 


,""" r.nllllilAn Nnr... 

Are You a Nurse? 

Here's an Opportunity To Be One. 

Primary Nursing 
.... .at the New Regional Hospital means having direct 
responsibility for the nur
ing care of your patient. his family, 
and working with the doctor as a coIleague. 

.....as a primary nurse means the outcome of your patient'
care is the measure of your effectiveness. 

.... .results from your role as a professional and the significant 
part you play in the care of your patient 

PlT IT TOGETHER with lhe new 300 bed Fort McMurray 
Regional Hospital Opening in November. 1979. 

Want to know more about your opportunities in our total 
patient care facilities? 

Call Penny Albers at (403) 743-3381 
Write for an information package: 

Personnel Department 
Fort McMurray Regional Hospital 
Fort McMurray, Alberta 
T9H I P2 


Government of 
Newfoundland & Labrador 

Public Notice 

Cottage Hospital Nurse I's 

Applications are invited for appointment on a permanent or 
short tenn basis to the Nursing Staff of the Cottage Hospitals 

Bonne Bay 

Harbour Breton 

Salary for Cottage Hospital Nurse I. annual. sick leave. 
statutory holidays and other fringe benefits in accordance 
with Nurses Collective Agreement. 

Living-in accommodations available at reasonable rates, also 
laundry services provided. 

Applications should be addre
sed to: 

Director of Nursing 
Cottage Hospitals Dhision 
Department of Health 
Confederation Building 
St. John's, Newfoundland 
AIC 5T7 

Lome A. Klippert. M.D. 
Deputy Minister 

Director of Nursing 

The Calgary General Hospital invites applications for the 
position of Director of Nursing Service. The Director will 
assume responsibility for a large nursing department covering all 
services in a 960-bed fully accredited active treatment teaching 
hospital. The nursing department is organized into seven clinical 

This position wi\l appeal to Nursing Managers who have 
demonstrated their leadership and organizational abilities in 
progressively senior administrative positions. Advanced 
preparation at the Master's level and experience in a large 
teaching hospital would be definite assets. 

Applications may be submitted in confidence 10: 

Mr. E. H. Knight, Executive Director 
Calgary General Hospital 
841 Centre Avenue E. 
Calgary, Alberta 

Telephone: (403) 268-9311 


841 Centre Avenue E. 
Calgary, Alberta T2E OA1 

Director of Nursing 

Applications are invited for this senior management 
position in a fully accredited multi-disciplinary treatment 
complex of 406 beds, including extensive out patient 
programmes. Reporting to the Executive Director, fully 
responsible for organization, planning, administration and 
operations of nursing care functions. 

Candidates must have current registration in Ontario, 
B. Sc.N. or Masters degree preferable, with demonslrated 
competent leadership abilities and previous nursing 
administrative experience at a senior level. 

Applicants are requested to submit a comprehensive 
resume and salary expectations to: 

G. E. Pickard 
Executive Director 
Windsor Western Hospital Centre Inc. 
1453 Prince Road 
Windsor, Ontario 
'\'9C 374 

The Canadien Nurse 

IIII rch 1lIIIO 117 

A Completely 
Modern Teaching Hospital 


Registered Nurses 




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This 500 bed general hospital is the major 
teaching facility for the Medical School of 
Memorial University of Newfoundland. 

Services offered - 

Critical Care, Medical, Surgical Coronary Care, 
General Surgery, Urology, Gynecology, 
Medicine, Nephrology, Clinical Teaching, 
Neurosciences, Cardiology, Cardiovascular 
Surgery, Orthopedics, Hemodialysis (kidney 
transplants), Emergency and Out Patient 
Services, active Rehabilitation Program (adult). 

The Staff Development and Training Department 
offers ongoing lectures and demonstrations in 
addition to a 6 month diploma course (twice 
yearly) in - Critical Care Nursing, 
Neurosciences, Operating Room Nursingo 

Located in St. John's, Newfoundland - the 
oldest city in North America with a population of 
120,000, offering cultural and recreation 
activities in a friendly atmosphere. 

Fishing, hunting, boating available 
approximately 10-14 miles outside the city. 

For information regarding salary and relocation 
expenses and other conditions of employment 
write or call - 

Miss Dorothy Mills 
Staffing Officer - Nursing 
The General Hospital 
Prince Philip Drive 
St, John's, Nfld, 
AIB 3V6 

TeJephone # (709) 737-6450 

!'IØ[ 1911Ð 

The University of Alberta 
Faculty of Nursing 

Applicants for positions beginning I July 1980. Master's degree 
and relevant clinical experience required; Post-Master's 
preparation or Ph.D. preferred. Teaching primarily in 
under-graduate programs (Basic and/or Post-R.N .), but some 
graduate teaching possible for suitable candidates;joint clinical 
appointments may be arranged for interested candidates. 

Two continuing vacancies exist; appointment possible at 
Assistant or Associate Professor rank depending on 
qualifications. Prefer candidates with some combination of 
pediatric, nurse-midwifery and/or community health 

Three full-time sessional appointees (8 month period) to replace 
staff on leave; rank and salary will depend on qualificationso 
Prefer candidates with administration, adult acute care or 
pediatric background. 

The University of Alberta is an equal opportunity employer. 

Please send enquiries and applications to: 

Dr. Amy Zelmer 
Faculty of Nursing 
Tbe University of Alberta 
Edmonton, Alberta 
T6G 2G3 

Nursing Opportunities in Vancouver 
Vancouver General Hospital 
If you are a Registered Nurse in search of a change and a challenge - 
look into nursing opportunities at Vancouver General Hospital, B.c. 's 
major medical centre on Canada's unconventional West Coast. Staffing 
expansion has resulted in many new nursing positions at all levels, 

General Duty ($1305. - 1542.00 per mo.) 
Nurse Clinician 
Nurse Educator 
Recent graduates and experienced professionals alike will find a wide 
variety of positions available which could provide the opportunity 
you've been looking for. 
For those with an interest in specialization. challenges await in many 
areas such as: 

Neonatology Nursing 

Intensive Care 
(General & Neurosurgical) 
Cardio- Thoracic Surgery 

Inservice Education 

Coronary Care Unit 
Renal Dialysis & Transplantation 

Burn Unit 

If you are a Nurse considering a move please submit resume to: 
Mrs. J. MacPhail 
Employee Relations 
Vancouver General Hospital 
855 West 12th Avenue Vancouver, B.C. V5Z IM9 

nlA ( .FInAn."," N",.ctll 

. ..; . 
.J .. 

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can go a long way 
. . ,to the Canadian North in fact! 


Canada's Indian and Eskimo peoples in the North 
need your help. Particularly if you are a Community 
Health Nurse (with public health preparation) who 
can carry more than the usual burden of responsi- 
bilityo Hospital Nurses are needed too.. 0 there are 
never enough to go around. 
And challenge isn't all you'll get either- because 
there are educational opportunities such as in- 
service training and some financial support for 
educational studies. 
For further information on Nursing opportunities in 
Canada's Northern Health Service, please write to: 

I Medical Servlcas Branch I 
Department of National Health and Welfare 
Ottawa, Ontario K1A OL3 
I Name I 
I Address I 
I City Provo I 
I .+ Health and Welfare Santé eI Blen-ëtre social I 
Canada Canada 

The t:'niversity of Western Ontario 

Graduate Program Coordinator 

Applications are invited for the above position 
coordinating an expanding graduate program 
currently enrolling 35 students. Canada's first 
M. Sc.N. program offers majors in Nursing 
Education and Nursing Administration. 

Duties involve overall program coordination, 
delegated administrative functions, curriculum 
development and teaching. 

Qualifications include Ph.D., university teaching 
experience, and demonstrated clinical competence 
Previous administrative experience is desirable. 

Salary is commensurate with academic and 
experiential background. 

Send curriculum vitae and references to: 

Dr. Beverlee Cox, Dean 
Faculty of Nursing 
The University of Western Ontario 
London, Ontario, Canada 

Association of Nurses of Prince Edward Island 

Executive Director/Registrar 

This position offers a unique challenge to nurses who have a 
broad background in all aspects of nursing. As this is the only 
professional nursing position in the employ of the association. it 
requires that the incumbent function in the capacity of advisor to 
educational programs in nursing, promote and direct research 
projects, write reports and briefs on diverse topics, as well as 
carry out the administrative and legislative functions of an 
Executive Director and Registrar of the professional association. 

Master's Degree in nursing or related discipline strongly 

Progressive nursing experience in which leadership and other 
educational and administrative skills have been demonstrated. 

The candidate must be eligible for licensure as a registered nurse 
in P.E.1. 

Salary: Negotiable, commensurate with education and 
experience. Contract available. 

Applications giving full details of education, qualifications and 
experience should be sent by March 25, 1980 to: 

Beth Robinson, Chairman 
Search Committee 
Association of Nurses of Prince Edward Island 
41 Palmer's Lane 
Charlottetown, Prince Edward Island 

Judy Hill Memorial Scholarships 

Appbc"tions are being recei.ed for two annual Scholarships. details of whIch are as 

Up to 13.500.00 each. 
To fund po".graduate nursing training (with special emphasis on public health 
ing. outpost nur
ing and midwifery) for a period of up to one year commencing 
July 1st, 1980. 
In Canada. the United Kingdom. AustraJia and New Zealand_ 
Should possess the followmg qualifïc"tions. 
Fluency in English; 
. R.N. Diploma. or equi.alent: 
A desire to ,,"ork for the Government of Canada or one of its Provinces at a fly-in 
nursing station in a remote area of Northern Canada for a minimum period of one year 
follow ing completion of the schola",Þip year 
A resume of acddemic and nursil18 career to date. together with a brief statement of 
the applicant's outside interests; 
Copies of educational qualifications submitted on entry to nursing school; 
A statement as to date of birth. marital ,t"tus. dependents (if any) and citizenship: 
Verification of R.N. Diploma. or equivaJcnt; 
. The proposed course of study and vcrification as soun as acceptance is received. 
Two character reference lelle",. One of these should be from a Health Service 
Professional (preferably a Nursing Supervisor) familiar with the Applicant's recent 
nursing experience. In reaching their decision. the Trustees attach considerable 
importance to the advice of the referees. 
Apply To 
Mr. PhilipG. C Ketchum. Chairman. The Board of Trustees, Judy Hill Memorial 
Fund. 15325 While mud Road. Edmonton. Alberta. Canada (f6H 4N5). 
Closin g date ror c ompletloo ohpplk.tlool - M.y Jlst, .980. 
. The Scholarship is contingent on the ,ucce..ful applicant belDg regIstrable by a 
nursing association in one of the Canadian Provinces and being a Canadian citizen or 
able to meet current Canadian requirements for employment with the Public Service 
ofCd.nadd._ Information regarding these requirements and regardil18 courses available 
in Can..da may be obtained from the Regional N uf'ing Director. Medical Services. 
Northwest Territories Region. Yellowknife. Northwest Territories. Canada. 

Advertising Rates 

For All Classified Advertising 

$20.00 tor 6 lines or less 
$3.00 for each additional line 

Rates for display advertisements on request. 

Closing date for copy and cancellation is 8 weeks prior 
to 1st day of publication month. 

The Canadian Nurses Association does not review the 
personnel policies of the hospitals and agencies 
advertising in the Journal. For authentic information, 
prospective applicants should apply to the Registered 
Nurses' Association of the Province in which they are 
interested in working. 

Address correspondence to: 

The Canadian Nurse 

50 The Driveway 
Ottawa, Ontario 
K2P IE2 

-.. MarcIL1HCI- 

Index to 

March 1980 

Abbott Laboratories 
Addison-Wesley Publishers 
Air Canada 
BaxterTravenol Laboratories of Canada 
(Division ofTravenol Laboratories Inc.) 
The Canadian Armed Forces 
The C anadian Nurse's Cap Reg' d 
The Clinic Shoemakers 
F.Ao Davis Co mpany 
Equity Medical Supply Company 
Gla xo Laboratories 
Frank W. Homer Limited 
J.B. Lippincott Comp any of Canada Ltd. 
The C.V. Mosby Compan y Limited 
Parke, Davis & Comp any Limited 
Pharmacia (Canada) Limited 
Procter & Gamble 
W. B. Saunders Company 
Smith & Nephew Inc. 
Stiefel LaboraIOries (Canada) Ltdo 
Upjohn Health Care Serv ices 
White Sister Uniform Inc. 


12, 13, IBC 

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Alb'ertisinR Manager 

Jean Malboeuf 
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St-Laurent. Québec H4L IX8 
Téléphone: (514)748-6561 

Gerry Kavanaugh 
fhe Canadian Nurse 
5U The Driveway 
Ottawa, Ontario K2P I E2 
Telephone: (613) 237-2133 

Gordon Tiffin 
19U Main Street 
Unionville, Ontario UR 2G9 
Telephone: (416) 297-2U30 

Richard P. Wilson 
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Telephone: (215) 363-6U63 

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Bu. En nomllle 
'hlrd .roo...... 
cl... cl.... 
· Exercise: how the body responds 

an- - 


· The ups and downs of an 
employee fitness program 
· Personalizing your fitness program 

· Marketing a healthy lifestyle 

· Incorporating lifestyle teaching 
into education 

APRIL 1980 



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e1979, Miles Laboratories Inc. 


Announcing the Hollister Secure 
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hls resened. 

 \' a 






- I 




Anne Be

.\ssistant Editors 
Judith Banning 
Jdne Bock 

Production .-\ssi
Gitd Dean 

Circulation \tanager 
Pierrene Hone 

Ad\ertising \tanager 
Gerry "-avanaugh 

C'A ExecutÏ\e Director 
Helen "-. \tu'

Editorial -\d\isors 

Mathilde Bazinet. chairman, Heahh 
Sciences Depanmenl. Canadore 
College. Nonh Bay. Onlario. 

Dorothv Miller 0 Pllblic rela/ion { 
o.l1ìcer. RegIStered Nurses "'"ociation 
of Nova Scolia. 

Jean Passmoreo editor. SRN .. news 
bulletin. Registered Nurses 
""sociation of Saskatche..an 

Peter Smith. director of pllblications, 
NationaJ GaJlery of Canada. 

Florita Vialle-Soubranne. cOr/{ultant, 
professionaJ inspection di,ision. Order 
of Nup,es of Quebec. 

Subscription Rates: Cdnada: one year. 
510.00: two vears. SI8.oo. Foreign: 
one year. $I
.oo: two years. S

Single copIes: $1.50 each Mal.e 
cheques or money orde,-" payable 10 
the Canadian Nurses Association. 

Chdnge of Address: Notice should be 
given in advance. I nclude previous 
dddress dS well as ne... along ..ith 
registration number, in a 
pro, inciaJ/territorial nurses 
association where applicable. Not 
responsible for journals lost in mail due 
to errors in address 

Canadian Nurses Association. 50 The 
Dn'ewav.Otta..a.Cdnada. K
P IE2. 

Fit to travel - Lifestyle is 
a matter of choice and 
that's what this issue is all 
about - whether you're 
backpacking in Kootenay 
National Park in Alberta 
or walking to work. Our 
cover photo is courtesy 
of fellow hiker Janet 
McEwen, RN, of Ottawa. 


April 1980 Volume 76, Number 4 
The officialjournaJ of the Canadian Nurses Association 
published in French and English editions eleven times per 



'WI 1 





Personal fitness..............33 

The body shop..............46 

Tomorrow's nurses.......49 

30 Exercise: How the body responds 43 What's the Score on Sports and 
Eye Injuries? 
Anne Redlin Susan Moses 
33 Fitting Nursing into Fitness 46 The Body Shop 
E. Lee Macnamara Anne Esler McMurray 
36 An Employee Fitness Program - 49 Tomorrow's nurses shape up for a 
Hospital Style healthy future 
Janet McEwen Kendy Bentley 
Bonnie Friesen 
39 The Stress Test 50 Save your ,own life 
Patricia MacFarlane Marion Logan 
41 Cardiac Rehabilitation: applying 
the benefits of exercise 
Barbara Naimark 
U News 21 Candidates for CNA 
HI Today's issues - Office 1980-1982 
tomorrow's nursing 
CN A convention 17 Calendar 5

The Canadian N line welcomes suggestions for anicles 
or unsolicited manuscnpts. Authors may submit 
finished anicles or a summary of the proposed 
content. \1anuscripts should be tvped double-spaced. 
Send original and carbon. All anicles must be 
submitted for the exclusive use of The Canadian 
Nllne. A biographical statement dnd return address 
should accompany all manuscripts. 

I SSf'< 0008-4581 

Indexed in International Nursing Index. Cumulative 
Index to Nursing Literatureo Abstracts of Hospital 
Management Studies. Hospital Literature Index. 
Hospital Abstracts. Index Medicus. Cdnadian 
PeriodIcal I ndex. The Canadian ,\ line is available in 
microform from Xerox University \1icrofdms. Ann 
Arbor. Michigan4RI06. 

The vie.. s expressed in the anlcles are those of the 
authors dnd do nO! nece"drilv represent the policies of 
the Canadian Nurses Association. 

l['oCdnadian Nurses Assoclallon. 19!!(). 

Guest editorial 
In order to promote a 
particular point of view, I 
believe that it is necessary to 
value it, by which I mean to 
give it high priority, gain 
knowledge about it, and role 
model or demonstrate 
associated behaviors. I 
question whether the nursing 
profession truly values fitness 
and healthy lifestyles to the 
extent that we give priority 
to have knowledge about, 
an'd role model healthy 
lifestyle behaviors. 
If we valued healthy 
lifestyle behaviors, we would 
take time to promote health 
behaviors in all clients. Health 
teaching related to smoking, 
diet, exercise, stress 
management and coping skills 
is seen as a nursing activity. 
How many of us consistently 
focus on this area of our 
practice? How much 
importance do we place on 
health teaching? Or is this 
something that we do only if 
there is time left over? 
Nursing claims to be 
involved in health promotion, 
yet the majority of us are 
illness oriented and indeed 
have more knowledge about 
the unhealthy body than the 
healthy body. Can we be a 
<<health-giving profession>> 
unless we have a knowledge 
base in health, nutrition, 
exercise and life skills, and 
skill in assessment, planning 
and intervention related to 
promotion and support of 
health behaviors? 
In relation to role 
modelling, I mUst ask 
whether we ourselves 
demonstrate he&lthy 
lifestyles. By this, I mean a 
lifestyle that contributes to 
both mental and physical 
fitness. Sporadic exercise is 
not enougho Let's take an 
honest look. A word of 
caution though, before you 
assess your lifestyle. The 
important thing is to strive to 
attain a healthier lifestyle, to 
attempt to maintain balance 
in your life, not to become 
The following are 
important areas to assess: 
. Do you smoke? 
. Do you overindulge in 
drugs or alcohol? 
. Do you overeat, eat 
non-nutritious foods, or 

II Aprll1980 







. Do you have a 
sedentary style of life? 
. Are you overweight? 
. Do you deal in an open 
way with problems and 
. Do you identify and 
manage stress periods in your 
. Do you balance activity 
with rest, work with play, 
thought with action? 
We do not often 
recognize how non-healthy 
lifestyle behaviors interfere 
with our ability to set goals, 
take risks, make decisions and 
handle conflicts. 
Right now lifestyle and 
fitness are terms that are 
regarded positively by the 
general public. Some of us in 
the nursing profession have 
responded by focusing on 
health promotion as a major 
nursing function. When the 
((fad>> aspect of lifestyle and 
fitness has faded will the 
nursing profession still be 
there and will it have the 
credibility . to work with 
others to maintain the high 
visibility of fitness and 
This April issue of CNJ 
marks a special effort to 
sensitize nurses to fitness and 
lifestyle. The authors focus 
on both knowledge and role 
modelling. We see evidence 
that some nurses are indeed 
diagnosing problems and 
developing interventions 
related to fitness and 
lifestyle. But this is not 
enough. Nursing education 
programs must develop and 
build curricula on nursing and 
health models. We must 

convince our employers and 
the government that fitness 
and lifestyle do payoff. We 
must begin research in this 
area to identify indicators of 
health and test out 
interventions related to 
promotion of health. Some of 
our closest colleagues in this 
work will be found in the 
areas of physical education, 
kinesthesiology, nutrition 
studies and health education. 
To promote a greater 
and lasting focus on health, 
the total nursing profession 
must be involved. I hope that 
this journal will help you 
look at your own lifestyle 
but, more than that, I hope 
that it will motivate you to 


,. 411rl 



take the steps to make health 
promotion a function of 
every nurse and a focus of 
our health care delivery 
Irmsjean Bajnok is assistant 
professor, Faculty of Nursing, 
University of Western 
Ontario. A member of the 
Middlesex North Chapter of 
the Registered Nurses 
Association of Ontario, she is 
past president of the RNA O. 
Irmajean is a graduate of 
the Winnipeg General 
Hospital School of Nursing 
and received her BScN from 
the University of Alberta and 
her MScN from the 
University of Western 
A year ago, in February 
1979 she addressed I 
unity health nurses 
attending the National 
Workshop on Fitness and 
Lifestyles at Geneva Park, 

The C.n.dl.n Nur.e 


We care about the shape 
you're in and so do the 
members of the Registered 
Nurse's Association of 
Ontario and the board of the 
VON for Canada. They 
indicated this when they 
proposed similar resolutions 
to CN A suggesting a special 
issue of the journal focusing 
on fitness and lifestyle. 
Initially, CNJ staff 
approached the project with 
the goal of presenting a 
complete look, a handy guide 
to encourage nurses to look 
at their own fitness level 
and lifestyle objectively and 
as well to incorporate some 
how to's for change both 
personally and professionally. 
It soon became apparent that 
this was an impossible task 
and that really all we could 
do was to attempt to 
stimulate some dialogue 
among Canadian nurses. 
Now, that this special 
issue is a reality, we look 
back on what has turned out 
to be a very rewarding 
experience for all of us. The 
experts whom we contacted 
for assistance responded with 
eagerness and, as word of the 
project spread, enthusiasm 
grew and we received 
contributions from nurses all 
across Canada. 
Next month we will 
continue our look at fitness 
and lifestyle as we explore 
what Canadian nurses are 
doing in their work areas: 
Judy Proulx of Cochrane, 
Alberta has coordinated a 
"fun a
d fitness" obesity 
clinic for children age six 
through fourteen; Frances 
Welch tells of her experiences 
with the Thunder Bay, 
Ontario Community Fitness 
campaign, a two-year project 
in which 22,000 citizens have 
already participated and Jean 
Nickerson, along with several 
of her Nova Scotia colleagues 
look at the impact of the 
fitness and lifestyle boom on 
occupational health nursing 
in that province. 
These and other nurses 
share their goals and 
experiences along the rocky 
road 'to program implemen- 
tation. Then to complete our 
look at lifestyle, we will 
be reporting on a national 
nutrition symposium taking 
place in Toronto in March.


NEW Op-Site 
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.Reg TM 


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Day O. Decubitus ulcer on inner ondv1us 
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va ....1 I 

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Reddened area before Op-Site. 

Protects sensitive skin 
Apply Op-Site to pressure areas at the first sign 
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Conforms to any body surface 
Op-Slte's hypoollergenic adhesive makes it fit 

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DAY S. Conventional 
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Day 7. Ulcer almast closed. 

Easy to apply, easy to remove 
Once you've learned how, Op-Slte IS faster to 
apply than tape and gauze. It adheres firmly 
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Apply Op-Site. 

One dressing is usually enough 
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surface moist and pliable. 
Seals out bacteria, urine, and feces 
Op-Slte is ideal for incontinent patients, because 
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A choice of sizes 
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Op-Slte dressings are wrapped IndIVIdually In 
sterilized peel-apart pouches 

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snugly and smoothly over any part of the body 
Op-Site stays put, even though the patient is 
being turned frequently. The patient can be 
washed, too, without dIsturbing the dressing. 
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Op-Slte is transparent. You can examine pressure 
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:5;": I 

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Smith & Nephew Inc. 
2100 52 Avenue 
lachine, Qué. HaT 2Y5 

-Reg. T M 

Vañcouver 1980 
Here it is... 


. .... 












 - ...,. 



Phyllis Barrett: executive 
secretary, Newfoundland 
Association of Registered Nurses. 

Lorine Besel: assistant professor, 
Faculty of Medicine (School of 
Nursing), McGill University; 
director of nursing, assistant 
executive director, Royal Victoria 
Hospital, Montreal. 

Norma Fulton: associate professor 
and director, Continuing Nursing 
Fducation, College of Nursing, 
Univcrsity of Saskatchewan, 









Kathleen M. Clark: education 
co-ordinator, Registered Nurses' 
Association of Ontario. 


Louise S. Lemieux-Charles: under 
contract with College of Nurses 
of Ontario tç develop a 
(<Blueprint for the Future of 
Nursing in Ontario)) - part-time 
counsellor, individuals and 

Aline Michaud: coordinator 
advisor, Labor Relations, 
F édération des Syndicats 
Professionnels D'Infirmières et 
D'Infirmiers du Québec 
(Fédération des SPIIQ). 





The Registered Nurses Association of British Columbia is looking 
forward to the CNA biennial meeting in Vancouver this June. As your 
hosts, we are planning a number of social activities. These will include 
breakfasts and lunches, as well as evening dinner tours to the Harbour 
Centre and Gastown, Grouse Mountain and Chinatown. A theatre 
evening and harbour crnise will also be offered during your stay. 
In addition to a variety of local tours during non-business hours 
of the convention, delegates will be offered post-convention tours to 
Waikiki and Maui, San Francisco. Alaska, Reno and Victoria. 
Vancouver is a beautiful city with its stunning mountains and 
sandy beaches. Its art galleries, museums, theatres and clubs are among 
the finest in the world. The cuisine is varied but specialties are the 
ethnic foods and seafoods. 
More information about social activities planned for you, both 
during the convention and after, can be found in the Febrnary issue 
of the Canadian Nurse. Additional details on activities will be sent to 
all registrants. We hope you enjoy your sray in Vancouver and thar 
you see as much as you can of our lovely city. 

Jessica Ryan: head nurse, 
Pediatric Service, Chaleur General 
Hospital. Bathurst, N.B. 

Judy Fraser, occupational health nurse, 
Winnipeg; Shelly Kremer, general duty 
nurse, Port Moody, B.c.; Roland Foucher, 
Université de Québec; Ruth BurstahIer, 
consultant in continuing education, 
Registered Nurses Association of B.C.; 
Rita Lussier, conseiller en formation 
professionnelle, OIIQ; Mægaret Steed, 
associate professor, director, Continuing 
Education, Faculty of Nursing, University 
of Alberta. 


Today's issues: tomorrow's nursing 

Sunday, June 22 


Canadian Nurses Foundation annual meeting 

Opening ceremonies 

Address, <<Primary Care-Nursing>>, Dr. Lea Zwanger, Tel Aviv. 
(Kellogg Foundation Lecture) 

RNABC reception for all regjstrants 


londay. June 23 


Keynote address: <<Who Shapes Nursing in the 80'sh, 
Lorine Besel 

Annual meeting 

CNA luncheon for all registrants (Guest speaker to be announced) 

Feature presentation, Canada's health care system and how it is 
financed, Malcolm G. Taylor, professor of public policy, 
Faculty of Administrative Services, York University (Toronto). 
Reaction panel 
· Phyllis Barrett (Nfld.) 
· Judy Fraser (Man.) 
· Shelly Kremer (B.C.) 
· Jessica Ryan (N.B.) 

<<M(.et your candidates>> (An opportunity for all registrants to meet 
candidates for 1980-82 term of office.) 
Tuesday, June 24 





President's address 
Executive director's report 

Election and luncheon 

<<Labor movement vis-a-vis the professional association>> 
· Professor Roland Foucher, labor analyst. 
· Aline Michaud, nurse. 
· Louise Lemieux-Charles, nurse. 

Dinner and entertainment (RNABC sponsored) for all registrants. 

Wednesday, June 25 

11 :15 


General Session 

Debate, (<Continuing education: mandatory vs. voluntary>> 
· Ruth Burstahler (B.C.) 
· Kathie Clark (Ont.) 
· Rita Lussier (Quebec) 
· Norma Fulton (Sask.) 
· Margaret Steed (A1ta.) 


Installation of officers 
President's address 


Hyatt Regency Hotel 
655 Burrard St. 
Vancouver, B.c. 
V6C 2R7 
CNA Convention Site... 

*$ 44.00 single 
58.00 double/twin 

o I wish to receive a reservation card for 
accommodation at the Hyatt Regency. 

Holiday Inn Centre 
1133 West Hasting
Vancouver, B.c. 
V6E 3T3 
(604-682-4541 ) 

Century Plaza 
1015 Burrard St. 
Vancouver. B.C. 
Travelodge toll free) 

Hotel Grosvenor 
840 Howe St. 
Vancouver, B.c. 
V6Z I N6 

*CNA convention rate 


*$ 38000 single 
42.00 double/twin 

*$ 34.00 single 
40.00 twin 
46.00 triple 

$ 32.00 Standard 
34.00 deluxe 
single or double 

Registration Fee 
(includes Monday luncheon and Tuesday 


CNA member 
Nursing student 

I wish to attend (days circled) 



Three days Daily rate 




Surname First 



Present employer 

Prov/Terr of Reg'n 

Reg'n No. 

I enclose cheque or money order payable to 
Canadian Nurses Association, 50 The 
Driveway, Ottawa, Ontario, K2P I E2 

Quality care 
comes from 
quality texts 





 'It o'u I HUIO... 



J>IIII>I'S . I ()
(; . W()()U1> .- 
Medical- ..c 
l surg
cal "0 

Ç) nursIng .... 

, 'II" 
j,. . 

New 7th Edttton! 
By Wilma J. Phipps, RN., Ph.D.: Barbara 
C. Long, RN.. M.S.N.: and Nancy Fugate 
Woods, RN.. M.N.. Ph.D. Through six 
edtUons. this classic has provided a clear 
understanding and approach to applied 
nursing care. The new 7th edtUon 
reflects a more logical progression of 
clinica1-surgica1 problems. You and your 
students wHl appreciate these key 
. instead of two sections, there are 
now five that allow students to more 
firmly grasp the correlation between 
body systems 
· six completely new chapters cover 
"Perspectives on health and Hlness," 
"Sexuality in health and Hlness," 
"Nursing process - an overview." 
"Qualityassuranceprograms toeval- 
uate nursing care:' "Death and 
dying:' and "The patient requiIing 
Intensive care nursing" 
. emphasizes a nursingcareapproach 
· presents up-to-date research on 
neoplasia. pain. sexuality. plus fluid 
and electrolyte balance/tmbalance 
March, 1980. Approx. 1,088 pp., 587 tIlus. 
About 828.75. 

12 April 1980 


and Clinical Practice 
Edited by Wilma J. Phipps. RN.. B.S.. 
AM.. Ph.D.: Barbara C. Long. RN.. M.S.N.: 
and Nancy Fugate Woods, RN.. M.N.. 
Ph.D.; with 46 contributors. Using both a 
conceptual and a systems approach. this 
innovative text reflects the myriad 
changes in contemporary 
medica1/surglca1 nursing. Highlights 
. a systems approach within a con- 
ceptual framework - your students 
will be able to locate Important 
Information quickly and better 
understand how specific medical 
details relate to total patieni care 
. a beginning section on "Perspectives 
for Nursing Practice" examines 
important issues students will face 
· a vi tal section on stress and 
. emphasizes total patient care 
You won't find a more useful 
combination of concepts with clinical 
practice! Assess this valuable text for 
yourself - then make It part of your 
classroom. 1979. 1.648 pp.. 731 Hlus. 
PIice, 832.50. 

The Canadian Nurse 

A CUentApproach to Nursing. By Janet 
Miller Barber. RN.. M.S.; Lillian Gatlin 
Stokes. RN.. M.S.; and Diane McGovern 
Billings. RN.. M.S. Focusing on the 
patient as client, this popular text 
integrates both adult and child care. 
according to basic human needs (safety 
and secuIi ty, activl ty and rest. sexual role 
satisfaction, need for oxygen. nutIition 
and elimination). You'll find: 
· In-depth Information on patho- 
physiologic processes 
· valuable mateIial on cardiovascular 
Illness, pathophysiology of cancer, 
and assessment techniques for 
congenital anomalies 
· Important data on nursing assess- 
ment of breast cancer. venereal 
disease. and rape 
More than 100 new illustrations and 72 
tables complement this 2nd edition. 
1977.1,050 pp., 7381llus. PIice, 828.75. 

___ Second edIIIon 


2nd Edition. PATIENT CARE STAN- 
DARDS. By Susan Martin Tucker. R.N.. 
B.S.N.. P.H.N.: Mary Anne Breeding. R.N.. 
B.S.: Mary M. Canobblo. R.N.. B.S.N.: 
Eleanor Vargo Paquette. R.N.. B.S.: 
Maljorte E. Wells, R.N.. B.S.: and Mary E. 
Willmann. R.N. Formulated to provide 
the needed guIdelines for developIng and 
plannIng qualIty nursIng care. thIs 
helpful text covers medical conditions. 
surgIcal Interventions. dIagnostic pro- 
cedures. chemotherapeutic agents. and 
related supportIve mechanical 
equIpment. HIghlights of thIs thoroughly 
revised edItion Include: 
. definl tions and laboratory values for 
each conditIon 
. thirty-two new standards have been 
. assessment tools. such as body 
system assessment. nutritional and 
psychosocIal assessment 
. expanded patient teachIng sections 
to Include "discharge outcome" 
Don't miss this Important new edition! 
March. 1980. Approx. 608 pp..I68lllus. 
About 820.50. 


6rD8r aad SbekietOil 

ceptualApproach. By Maureen E. Groër. 
RN.. Ph.D. and Maureen E. Shekleton. 
RN.. B.S.N.. M.S.N. The authors of this 
useful text have organIzed the vast field 
of pathophysiology Into major conceptual 
areas. Students wiIl study various 
disease entities as they relate to such 
concepts as ceIlu1ar deviation. body 
defenses. physIcal and chemIcal 
equIlibrium. nutritional balance. 
reproductive and endocrine Integrity. 
and structural and motor Integrity. 
Noteworthy discussIons Investigate: 
. Immunopathology 
. agIng as a genetic process 
. atherosclerosis 
. dIabetes and obesIty 
. Immune viral organIsms of human 
Helpful behavioral objectives begIn each 
chapter. 1979.534 pp.. 4231llus. Price. 

Thompson. R.N.. M.S. and Arden e. 
Bowers. R.N" M.S. March. 1980. Approx. 
544 pages. 487 illustrations. About 
Malasanos. R.N.. Ph.D.: Violet 
Barkauskas. R.N.. e.N.M.. M.P.H.: Murtel 
Moss. R.N.. MA: and Kathryn 
Stoltenberg-Allen. R.N.. M.S.N. 1977. 538 
pages. 769 illustrations. Price. 826.00. 

Let Mosby 
give your students 
the up-to-the-minute 
they can depend on. 

Thê Canadian Nurse 

implications of 
laboratory tests 



TI/klan. M.D.: Mary Boudreau Conover. 
R.N., B.S.N.Ed: and Am G. TI/kian. M.D.. 
FAe.e. Answer your students' questions 
on the sIgnIficance of labora tory test 
results with thIs concise resource! Using 
an effective. step-by-step approach. the 
text emphasizes physiological 
Implications, variations. and Interrela- 
tionshIps oflaboratory values. This 2nd 
. offers handy sections on patient 
preparation. Instruction. and 
. replaces the chapteron serodiagnos- 
tic tests with two new chapters on 
rheumatoid and Infectious dIseases 
. provides an extensIvely revised 
chapter on gastroenterology 
. reflects the latest research In the 
table of normal values 
1979.334 pp.. 451llus. PrIce. 812.00. 
A Handbook for Practice. By Charlene 
Coco. R.N.. B.S.N. Your students can 
unravel the Intricacies of IV therapy with 
the help of thIs handy guIde! 
EmphasizIng the nursIng process. thIs 
long-awaited book explores adult IV 
therapy. Up-to-the-mInute dIscussions: 
. present the rationale underlying IV 
therapy and venipuncture 
. teach students to recognIze both 
therapeutic and deleterious effects 
. examIne nursIng actions relating to 
. outlIne legal aspects 
. study pharmacodynamIcs 
Both chapter and general references add 
to the usefulness of thIs comprehensive 
new text. February. 1980. 182 pp.. 55 
Illus. Price, 812.00. 


For more Information. please write: 



M4B 3E5 

Aprlll980 13 


nursing abstracts 

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4'13eJlsqe l)u!sJnu SI38JIsqe l)u!sJnu SI38JIsqe 8U\,f; 

Students & Graduates 



P.O. BOX 634 

To receive a free sample of our "needs no starch" cloth, 
and more information, please clip this coupon and mail 

Name ..............................................0.0..... 
(block Iett....) 
Address ................................................... 

City ................................... .Postal Code ....... 

Your graduation school .................................... 

14 April 1980 


CNA's Task Group-a set of Principles for Standards 
The definition and standards by project coordinator, Dr. 
for nursing practice Task Ruth MacKay. Some papers 
Group has established a set of on research in nursing 
principles upon which to base education and nursing 
the development work administration where the 
underway. connection is made to 
· "We recognize and nursing practice may be 
endorse the use of a includedo Any nurse 
conceptual model for nursing researcher practicing in 
practice, education and Canada may submit papers 
research in any setting, which must be accompanied 
acknowledging that by an abstract of 100-175 
administration is an integral words and a current 
component in each area. curriculum vitae. 
· Respecting the freedom Applications to attend 
of informed choice, we will the conference are invited 
not impose upon others, our from interested nurses and 
choice of anyone of the researchers from other 
various nursing models that disciplines involved in 
exist. This freedom of choice multidisciplinary research 
will allow for the utilization with nurses. Registration is 
of a number of nursing limited to 200 persons. (Fee 
models, their eventual testing is $140 rising to $160 after 
and further refinement, as September 15 0 Registrants 
well as the construction of should make their own hotel 
new models. accommodation). 
· We believe that the use The four sponsoring 
of a conceptual model will associations are: New 
contribute to improved Brunswick Association of 
quality of nursing practice, Registered Nurses, Registered 
since it provides direction for Nurses Association of Nova 
the development of Scotia, Association of Nurses 
behavioral indicators required of Prince Edward Island and 
to evaluate that practice. Association of Registered 
· We perceive the nursing Nurses of Newfoundland. The 
process to be the means by Faculty/Schools of Nursing 
which the conceptual model are Memorial University of 
will be applied in nursing Newfoundland, Dalhousie 
practice. University, St. Francis Xavier 
· Since nursing education University, University of New 
prepares future practitioners Brunswick and Université de 
and nursing research Moncton. 
contribures to both education Information: Coordina- 
and practice, a conceptual tor, Research - Nursing in 
nursing model is equally the 80's Conference, School 
important to each field of of Nursing, Dalhousie 
activity." University, Halifax, N .S. 
This project is one of B3H 4H7. 
the most important CNA 
Biennium priorities moving 
into the final phase and 
aiming at an Annual 
MeetingfConven tion target. 

Research in the '80's 
Fall Conference Theme 

Four professional nursing 
associations and five 
university Faculty/Schools of 
Nursing in the Maritimes will 
co-sponsor "a conference, 
"Research Basis for Nursing 
in the Eighties", October 22, 
23 and 24 at the Hotel Nova 
Scotian in Halifax. 
A call for papers 
describing basic or applied 
research in the practice of 
nursing has been announced 

The CAr'\H IAn NllrlllA 

Did you know... 
The Health Computer 
Information Bureau in 
Ottawa is the first attempt in 
the world to establish a 
central facility for 
information on computer use, 
and users, in the health 
field. The Bureau wishes to 
facilitate the exchange of 
information by publishing a 
catalogue of user names and a 
description of the types of 
computer applications in 
Canada. To give information 
or to learn more about the 
Bureau, contact Marjorie 
Hayes, RN, BScN, MScN, 
director, 410 Laurier Avenue 
West, Suite 800, Ottawa, 
Ont. KIR 7T6.'" 


Nurses look at new ways of helping 'young old' and 'old old'. 

Gerontological nursing is 
working on a new image, 
one that